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Reduction in red blood cell transfusion associated with engagement of the ordering physician
Author(s) -
Tavares Maria M.,
Diquattro Pamela J.,
Sweeney Joseph D.
Publication year - 2014
Publication title -
transfusion
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.045
H-Index - 132
eISSN - 1537-2995
pISSN - 0041-1132
DOI - 10.1111/trf.12552
Subject(s) - medicine , psychological intervention , emergency medicine , transfusion medicine , blood transfusion , red blood cell transfusion , intervention (counseling) , red blood cell , hemoglobin , prospective cohort study , pediatrics , intensive care medicine , nursing
Background Data on red blood cell (RBC) transfusion in the U nited S tates show variation in practice and overprescribing or overdosing is considered to be prevalent. Education or restrictive interventions could modify practice. Study Design and Methods RBC transfusion and mortality rates were recorded in a single institution over a 15‐year period. The first 3 years were used as a baseline. Education measures were used to influence practice for 3 years followed by a 9‐year period when questionable RBC orders in nonbleeding inpatients resulted in prospective physician notification for potential modification. Physician notification was done by blood bank technologists with transfusion medicine physician support, if needed. Pretransfusion hemoglobin levels of more than 9 g/ dL were recommended for cancellation and levels between 8 and 9 g/ dL advised for a single unit, if 2 or more units were requested. RBC transfusion rates were described as inpatient units per 1000 discharges to allow for interyear comparison. Results A downward trend in RBC transfusion was noted for the intervention period. Comparison of the baseline period with the past 3 years of the intervention period showed an approximate 33% decrease, which was highly significant (508 ± 66 vs. 341 ± 32, p < 0.01). Inpatient mortality rates declined over this period. Conclusion Physician education in appropriate transfusion practice is desirable but may not greatly impact RBC use. Engagement of physicians who prescribe RBCs that appear inappropriate for indication or dose was associated with a significant decline in RBC use without evidence of a change in mortality.