Durability of response to a targeted intervention to modify clinician transfusion practices in a major teaching hospital

Abstract

Objectives To determine the durability of a successful intervention to modify clinician transfusion practices, and to compare current transfusion practices in the “intervention” hospital with those in a hospital with no intervention. Design Prospective, descriptive study. Setting Two major metropolitan teaching hospitals — Royal Melbourne Hospital and Western Hospital, Footscray. Subjects Consecutive patient transfusion episodes for red cells, platelets and fresh frozen plasma (FFP). Outcome measures Appropriateness of transfusion according to intervention guidelines; comparison of inappropriate transfusion rates before the intervention, immediately after the intervention and 3 years alter the intervention. Comparison of inappropriate transfusion rates in intervention and non‐intervention hospitals. Results Inappropriate transfusion rates 3 years after the intervention were 20% for red cells, 27% for platelets, and 43% for FFP. These were significantly higher than equivalent rates reported immediately after the intervention. Inappropriate transfusion rates at the non‐intervention hospital were comparable (26% for red cells, 36% for platelets and 52% for FFP). Conclusion Appropriate clinician transfusion practices have proven difficult to sustain 3 years after hospital guideline generation and promotion. A “gate‐keeping” role by hospital blood bank staff proved impractical in the long term.

Appropriateness of red blood cell transfusion in Australasian intensive care practice

“…That single‐centre study evaluated 200 transfusion episodes and 558 units of transfused RBCs in a 60‐day period in 1993 and included both general ward and intensive care patients. More recently, in a retrospective audit, the rate of inappropriate transfusion in the same institution was 20% 5 . In a multicentre study in metropolitan Sydney, the rate of inappropriate transfusion was 35% 6 .…”

“…Why then is the rate of inappropriate transfusion in our ICU patients so low? Previous studies 5 ‐ 7 examining transfusion practice in Australia were conducted in 1993–1999. There are no data as to the rate of inappropriate transfusion in intensive care units in this period.…”

“…Concerns about the rate of inappropriate transfusion exist, particularly given the recognised risks of transfusion 3 and the decreasing availability of donor blood 4 . Previous studies of RBC transfusion in Australian hospitals have found rates of inappropriate transfusion between 16% and 30% 5 . ‐ 7 …”

Clinical audit of the use of fresh‐frozen plasma and platelets in a tertiary teaching hospital and the impact of a new transfusion request form

“…The use of a transfusion‐specific request form has allowed a further improvement in appropriate requests, with an overall satisfactory compliance. It would be interesting to assess the impact if the provision of indication and laboratory data was made mandatory and the durability of its usefulness with time 15 . Overall, the form facilitates best transfusion practices, promotes self‐education to new staff and allows auditing of this nature to be carried out easily 16 .…”

Clinical Support Systems Program: why do we need clinical practice improvement? A government perspective

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