Transfusion insurgency: practice change through education and evidence-based recommendations

Area of Science:

• Medicine
• Critical Care Medicine
• Transfusion Medicine

Background:

• An evidence-based transfusion guideline with a hemoglobin threshold of <8 g/dL was implemented in a surgical intensive care unit (SICU) in 2000.
• The study aimed to assess the impact of ongoing education on adherence to this transfusion protocol.

Purpose of the Study:

• To evaluate the effectiveness of an evidence-based transfusion guideline in reducing packed red blood cell (PRBC) transfusions.
• To determine the impact of the guideline on patient outcomes, including mortality and length of stay (LOS).

Main Methods:

• A retrospective analysis of patient admissions during 2-month periods in even-numbered years from 1998 to 2006.
• Inclusion of all packed red blood cell (PRBC) infusions in the analysis.
• Comparison of transfusion data before and after guideline implementation.

Main Results:

• Transfusions decreased from 3.2 ± 0.34 to 1.7 ± 0.2 units per patient.
• The number of patients receiving PRBC transfusions also decreased.
• Mortality and length of stay (LOS) remained unchanged, but each unit of PRBCs increased mortality risk by 14%.

Conclusions:

• The evidence-based transfusion guideline successfully reduced PRBC utilization and the number of transfused patients.
• The guideline implementation did not lead to an increase in mortality, despite an observed increase in renal failure cases in 2006.
• A higher transfusion threshold may be beneficial, as increased units transfused correlated with increased mortality risk.