Behaviour modification interventions to optimise red blood cell transfusion practices: a systematic review and...

Area of Science:

• Transfusion Medicine
• Healthcare Interventions
• Evidence-Based Practice

Background:

• Restrictive red blood cell (RBC) transfusion practices are increasingly recommended.
• Behavior modification interventions aim to align clinical practice with these recommendations.
• The overall impact of such interventions requires systematic evaluation.

Purpose of the Study:

• To assess the effectiveness of behavior modification interventions in promoting restrictive RBC transfusion practices.
• To evaluate the impact on transfusion rates, appropriateness, and patient outcomes.

Main Methods:

• Systematic review and meta-analysis of randomized controlled trials (RCTs) and non-randomized studies.
• Searched seven electronic databases up to January 2018.
• Analyzed studies examining interventions to modify healthcare providers' RBC transfusion practices.

Main Results:

• Eighty-four studies (3 RCTs, 81 non-randomized) were included.
• Interventions were associated with reduced odds of transfusion (OR 0.63), inappropriate transfusion (OR 0.46), and fewer RBC units per patient (-0.50 units).
• Protocol/algorithm and multimodal interventions demonstrated the greatest reduction in transfusion rates.

Conclusions:

• Behavior modification interventions, particularly protocol/algorithm and multimodal approaches, are effective in reducing RBC transfusions.
• Despite limitations in study quality (predominantly non-randomized), pooled analysis shows significant improvements.
• Future research should focus on identifying the most effective and cost-efficient interventions ('what works best and at what cost?').