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Improving preoperative haemoglobin using a quality improvement approach to treat iron deficiency anaemia.

In this article, the authors present their approach to the treatment of iron-deficiency anaemia in patients presenting for elective oesophagogastric surgery. These patients had a high incidence of preoperative anaemia which was not managed prior to surgery.

The authors used a quality improvement (QI) approach and report their experience over three plan-do-study-act (PDSA) cycles in 2015, January 2018 and November 2018. The key members of the preoperative assessment clinic were two anaesthesiologists and two specialist nurses. The intervention, administration of intravenous iron, was delivered within the structure of the current patient pathway, in order to avoid adding to the burden of the patient’s appointments. A change in iron preparation allowed the administration of higher doses during the second and third PDSA cycles.

The incidence of preoperative anaemia declined from 10% in 2014 to 1.6% in 2018 while blood transfusion rated declined from 16% to 6.5% during the same time period. The number of units transfused was reduced by 63%.

I recommend this article to all clinicians striving to set up a preoperative anaemia clinic. While incomplete (only iron-deficiency anaemia was addressed), the authors suggest a no-nonsense and effective approach to the management of preoperative anaemia.

– Jean-François Hardy