Impact of Implementing a Cost-Effective Nurse-Led Intra-Operative Cell Saver Service in Reducing Allogeneic Red Blood Cell Transfusions in Singapore General Hospital: A Quasi Experimental Retrospective Study

OBJECTIVES: Previously, the ICS service in Singapore General Hospital was vendor-led at SGD$3,300/case. Since April 2023, ICS has been managed by Anesthetic Unit Nurses through job re-engineering, at a reduced cost of SGD$686/case with no additional manpower. The study investigated whether the introduction of nurse-led ICS service significantly reduces the number of allogeneic red blood cell (RBC) bags transfused per patient.

METHODS: This quasi-experimental retrospective study employed a pre-post design with a double pre-test approach. Data were collected from patients who underwent major surgeries (excluding cardiac surgeries) in SGH with documented blood loss of > 500ml. Changes in the number of allogeneic RBC bags transfused per patient were analyzed using one-way ANOVA, with post-hoc analysis to determine specific differences between periods. Additionally, 30-day transfusion related complications were monitored.

RESULTS: The one-way ANOVA indicated a statistically significant difference in the number of allogeneic RBC bags transfused per patient across the three periods (two pre-intervention periods and post-intervention period).

On further analysis, there was no significant change in the number of allogeneic RBC bags transfused per patient between the two pre-intervention periods. However, significant changes were observed when comparing the pre-intervention periods to the post-intervention period.

No 30-day transfusion-related complications were recorded during the study periods. The ICS uptake increased from median of 1.8% to 11.8%. With estimated 1,500 surgeries annually, there was a cost avoidance of SGD$460,200 from the conversion from vendor-led service to nurse-led service, and a cost avoidance of SGD$39,168 from reduced transfusion (each pack at SGD$258).

CONCLUSIONS: The findings suggested that the implementation of nurse-led ICS service had a positive impact in reducing allogeneic RBC transfusions with total annual cost avoidance of SGD$499,368.