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The authors engaged a multidisciplinary team and assessed the impact of input from multiple stakeholders on the evolution of a comprehensive quality improvement protocol aimed at reducing or eliminating blood transfusion in patients undergoing open surgery for craniosynostosis.<\/jats:p><\/jats:sec><jats:sec><jats:title>METHODS<\/jats:title><jats:p>Over a 4-year period from 2012 to 2016, 39 nonsyndromic patients were operated on by a single craniofacial plastic surgeon. Initially, no clear blood conservation protocol existed, and specific interventions were individually driven. In 2014, a new pediatric neurosurgeon joined the craniofacial team, and additional stakeholders in anesthesiology, transfusion medicine, critical care, and hematology were brought together to evaluate opportunities for developing a comprehensive blood conservation protocol. The initial version of the protocol involved the standardized administration of intraoperative aminocaproic acid (ACA) and the use of a cell saver. In the second version of the protocol, the team implemented the preoperative use of erythropoietin (EPO). In addition, intraoperative and postoperative resuscitation and transfusion guidelines were more clearly defined. The primary outcomes of estimated blood loss (EBL), transfusion rate, and intraoperative transfusion volume were analyzed. The secondary impact of multidisciplinary stakeholder input was inferred by trends in the data obtained with the implementation of the partial and full protocols.<\/jats:p><\/jats:sec><jats:sec><jats:title>RESULTS<\/jats:title><jats:p>Implementing the full quality improvement protocol resulted in a 66% transfusion-free rate at the time of discharge compared to 0% without any conservation protocol and 27% with the intermediate protocol. The administration of EPO significantly increased starting hemoglobin\/hematocrit (11.1 g\/dl\/31.8% to 14.7 g\/dl\/45.6%, p &lt; 0.05). The group of patients receiving ACA had lower intraoperative EBL than those not receiving ACA, and trends in the final-protocol cohort, which had received both preoperative EPO and intraoperative ACA, demonstrated decreasing transfusion volumes, though the decrease did not reach statistical significance.<\/jats:p><\/jats:sec><jats:sec><jats:title>CONCLUSIONS<\/jats:title><jats:p>Patients undergoing open calvarial vault remodeling procedures benefit from the input of a multidisciplinary stakeholder group in blood conservation protocols. Further research into comprehensive protocols for blood conservation may benefit from input from the full surgical team (plastic surgery, neurosurgery, anesthesiology) as well as additional pediatric subspecialty stakeholders including transfusion medicine, critical care, and hematology.<\/jats:p><\/jats:sec>","DOI":"10.3171\/2020.4.peds19633","type":"journal-article","created":{"date-parts":[[2020,6,19]],"date-time":"2020-06-19T07:07:14Z","timestamp":1592550434000},"page":"406-414","source":"Crossref","is-referenced-by-count":12,"title":["Impact of multidisciplinary engagement in a quality improvement blood conservation protocol for craniosynostosis"],"prefix":"10.3171","volume":"26","author":[{"given":"David E.","family":"Kurlander","sequence":"first","affiliation":[{"name":"Case Western Reserve University, Cleveland;"},{"name":"Plastic Surgery,"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mona","family":"Ascha","sequence":"additional","affiliation":[{"name":"Case Western Reserve University, Cleveland;"},{"name":"Plastic Surgery,"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Danielle C.","family":"Marshall","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, University of Miami Hospital, Miami, Florida"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Derek","family":"Wang","sequence":"additional","affiliation":[{"name":"Case Western Reserve University, Cleveland;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mustafa S.","family":"Ascha","sequence":"additional","affiliation":[{"name":"Case Western Reserve University, Cleveland;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Paul A.","family":"Tripi","sequence":"additional","affiliation":[{"name":"Case Western Reserve University, Cleveland;"},{"name":"Anesthesiology, and"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hollie M.","family":"Reeves","sequence":"additional","affiliation":[{"name":"Case Western Reserve University, Cleveland;"},{"name":"Pediatrics, University Hospitals Rainbow Babies & Children\u2019s Hospital, Cleveland, Ohio;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Katharine A.","family":"Downes","sequence":"additional","affiliation":[{"name":"Case Western Reserve University, Cleveland;"},{"name":"Pediatrics, University Hospitals Rainbow Babies & Children\u2019s Hospital, Cleveland, Ohio;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sanjay","family":"Ahuja","sequence":"additional","affiliation":[{"name":"Case Western Reserve University, Cleveland;"},{"name":"Pediatrics, University Hospitals Rainbow Babies & Children\u2019s Hospital, Cleveland, Ohio;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alexandre T.","family":"Rotta","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Duke University, Durham, North Carolina; and"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Gregory E.","family":"Lakin","sequence":"additional","affiliation":[{"name":"South Florida Center for Cosmetic Surgery, Fort Lauderdale, Florida;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Krystal L.","family":"Tomei","sequence":"additional","affiliation":[{"name":"Case Western Reserve University, Cleveland;"},{"name":"Departments of Neurological Surgery,"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1754","reference":[{"issue":"7","key":"b1","series-title":"Plast Reconstr Surg","doi-asserted-by":"publisher","first-page":"2190","DOI":"10.1097\/00006534-200206000-00002","article-title":"The use of recombinant erythropoietin in the reduction of blood transfusion rates in craniosynostosis repair in infants and children","volume":"109","author":"Fearon JA","year":"2002","unstructured":"Fearon JA, Weinthal J. 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