Optimising Intravenous Iron Administration in Ambulatory Care Unit: a Quality Improvement Project

Introduction

Iron deficiency anaemia (IDA) is one of the most common reasons for referral to day-case settings, reflecting its significant contribution to global morbidity and disease burden. In 2017/2018, over 100,000 treatments were delivered nationally at a cost of £465 million – averaging £449/ case. Locally in South London, a single trust treats 50-60 patients monthly. In the general population , anemia is defined as a haemoglobin <130g/L in men and <120 g/L in non-pregnant women, in association with a serum ferritin<30 mg/L (in the absence of inflammation).The diagnostic criteria differs for those with chronic kidney disease, heart failure with reduced ejection fraction. National guidelines recommend oral iron as first-line therapy for most patients however intravenous iron should be considered in those who cannot tolerate or absorb oral iron, require rapid replenishment, or have comorbidities.

Method: Baseline data was collected during a one-month period from July-August 2024. Interventions included:

1. Development and implementation of a referral pathway, integrating local guidelines.
2. Education with emergency department (ED) targeting the definition of IDA in general and specialist populations, guideline-directed indications for IV versus oral iron, and the importance of conducting timely iron studies.

Results: 109 patients between the ages of 16-95, were referred for IV iron from multiple sources including medical specialties 51%, ED 28%, GP 17% and surgery 4%. Post-intervention analysis demonstrated an increase in the proportion of patients referred in accordance with local guidelines 71%to79% and an increase in the proportion of patients who had timely iron studies 68% to 81%. There was a reduction in the percentage of patients receiving non-concordant IV iron 18%to13%.

Conclusion: The implementation of an electronic IV iron referral pathway, coupled with education, led to measurable improvements in the quality and appropriateness of IV iron administration. It also contributed to more cost-effective practice.