Medicine Hat Regional Hospital

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Optimization of Transfusion Practices

 

Project Lead: Dr. Susan Witt

Other Team Members: Dr. M. O’Connor, Dr. Joanna Slusar, Ken Wou, Konra Mueller

 

Anemia is a common problem in hospital medicine.  Transfusion of red cells, at a predetermined level, in the absence of symptoms can be commonplace, as is transfusing red cells in blocks of units.  Recent evidence suggests that arbitrary transfusion at hemoglobin levels above 7 g/dL in patients without active coronary artery disease or hemodynamic instability in the case of GI bleeds, worsens outcomes (higher mortality and higher re-bleeding in GI bleeds). Medicine Hat Regional  Hospital (MHRH) historically used 8 g/dL as a critical value for physician notification but this was changed on September 8, 2015 to align with provincial and national trends in reporting.  Unnecessary transfusion may put patients at risk of transfusion reaction, fluid overload, blood borne illness and may adversely affect hospital length of stay.  Blood products are also a limited resource and the decision to transfuse may be better assessed in association with the patient’s clinical condition, rather than an arbitrary lab value.  Block transfusions may add to the volume of unnecessary transfusions.  With this project MHRH hopes to assess present inpatient transfusion practice (excluding paediatrics, palliative care & ICU) at our regional hospital site and use an educational intervention in the hopes of decreasing arbitrary transfusions of packed red blood cells.

 

 

Non-ICU Telemetry Utilization

 

Project Lead: Dr. Susan Witt

Other Team Members: Kirby Peterson

 

Telemetry is a limited resource and its indiscriminate use can pose a barrier to discharge from the ICU as well as impairing the flow of patients from the ED to the acute care ward. At Medicine Hat Regional Hospital, anecdotal information, observation and experience suggest the use of non-ICU telemetry has the potential to be optimized. This project will examine the present state of telemetry usage and focus on reducing inappropriate utilization.

 

 

Reducing in Hospital Catheter Usage

 

Clinical Lead: Dr. Susan Witt

Other Team Members: Kirby Peterson

Urinary catheters are a frequent cause of hospital acquired infection. They are associated with increased morbidity and delirium in the elderly. Project objectives are to increase the awareness of the appropriate use of urinary catheters and integrate this knowledge into hospital practice.