Dissertations & Theses (Open Access)

Date of Award

Fall 12-16-2022

Degree Name

Doctor of Philosophy in Nursing (PhD)


Cathy L. Rozmus, PhD

Second Advisor

Constance Johnson, PhD

Third Advisor

Adam M. Vogel, M.D.

Fourth Advisor

Heidi Russell, M.D.



Red blood cell (RBC) transfusions can be a life-saving and important intervention used to replace blood loss or manage anemia, but they also come with risks from transfusion-associated adverse events (TAAEs). Patient blood management (PBM) involves a multidisciplinary approach to optimize care of patients who may need a transfusion, including blood conservation modalities, patient-centered decision making, among others. The impact of PBM in the pediatric setting is not well understood, particularly the impact on TAAEs and the economic impact of these programs.

The following specific aims were pursued: (1) To investigate the effect of a PBM program on transfusion utilization and the incidence of TAAEs, and (2) to compare the costs related to supporting a health-system level PBM program to the costs of transfusion utilization.


This study used a retrospective cohort design to evaluate the impact of a PBM program on patient outcomes in a pediatric hospital system. Clinical and demographic information from pediatric patients between the ages of four months and eighteen years who had an inpatient hospitalization were compared for the year prior to the program (2015) and the year post-implementation (2019). Transfusion utilization was compared before and after the program using generalized estimating equation. A cost-benefit analysis examined program costs and compared them to program outputs.


This study examined a total of 35,245 hospitalizations and over 3,800 transfusions in the pre- and post-intervention years. The post-intervention year had lower pre-transfusion hemoglobin values and smaller volumes of RBC transfusions ordered, and this was statistically significant (p<0.01). While this study did not see a statistically significant difference in the incidence of TAAEs, fewer hospitalizations had RBC transfusions ordered in 2019 when compared to 2015. When examining transfusion utilization while adjusting for potential confounders, group year was not statistically significant (p = 0.11). Overall, activity-based transfusion costs based on projections were higher in the post-intervention year.


This study explored the impact of a PBM program on pediatric hospitalized patients at a large tertiary academic medical center. The results suggest that this work was effective in reducing the mean hemoglobin pre-transfusion for RBC transfusion and reduced the mean volume of transfusion when adjusted for severity of illness and length of stay. The results of the cost-benefit analysis suggest that this investment in safety did not correspond with decreased utilization costs, but there were limitations in the analysis. More research is needed to understand the impact of reductions in transfusion-associated adverse events and their true cost.


patient blood management, transfusion safety, cost-benefit analysis

Included in

Nursing Commons



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