Reducing red cell transfusion by audit, education and a new guideline in a large teaching hospital

Abstract

Safety concerns combined with the greatly increased costs and difficulties of maintaining the blood supply are major considerations for transfusion services. Previous local surveys demonstrated that hospital blood use at our hospital could be improved. Excessive cross-matching, unnecessary transfusion and high return rates of unused blood were commonplace. Transfusion practice was audited over a 3-month period. An education package with guidelines for transfusion was delivered to all clinician groups within the hospital, over the following 9 months. The audit was repeated exactly 1 year later at the same time period. During the second audit, inpatient hospital numbers increased by 1.02% (from n = 7262 to n = 7336) but no differences in length of stay, cardiovascular morbidity or mortality were demonstrated. Twenty percent (n = 254, 2002; n = 316, 2001) fewer patients received blood, and the number of red cell packs used reduced by 19% (from n = 1093 to n = 880). Total number of patients transfused reduced from 4.4% to 3.5% which, as an absolute difference, is a reduction of 0.9% (CI 0.3-1.5, P = 0.006). The audit, guideline and education package had a major impact on red cell use within the hospital with no adverse effects. Blood use can be improved by the implementation of a suitable education package and guideline. If it is possible to replicate the results of this education programme nationwide, the effect on blood use, with subsequent savings and enhanced patient safety could be significant.

A retrospective one-year single-centre survey of obstetric red cell transfusions

“…Adequate education about appropriate blood use should target these later transfusions, which could potentially reduce the demand for blood; the effect of provider education on the use of blood has previously been highlighted. 12,18,19 Overall there appeared to be a low threshold for giving a red cell transfusion. It is appreciated that identifying symptoms of anaemia is difficult as such symptoms are often non-specific and highly subjective.…”

“…12,18,19 This retrospective study preceded the publication of the RCOG national guidelines on blood transfusion that are intended to be incorporated into a protocol for all obstetric units in the UK. It is hoped that future audits following the implementation of these guidelines in the obstetric department at the John Radcliffe Hospital will replicate the same success in reducing red cell transfusion.…”

“…In a large Glasgow teaching hospital, audit of transfusion practice before and after such education revealed that the number of patients transfused was reduced from 4.4 to 3.5% (0.9% [CI 0.3-1.5, P=0.006]) and 19% fewer red cell packs were used. 12 A number of published audits of red cell transfusion practice have revealed similar results, 13-15 but none has focused on obstetrics.…”

Strategies for reducing the exposure to donor blood

“…Audits carried out before the initiative and after one year showed that red cell use had decreased by 20%, with no demonstrable effect on morbidity or mortality. 20 …”

Blood utilization: fostering an effective hospital transfusion culture

“…Although cardiovascular morbidity, mortality, and length of stay did not change, 20% fewer patients received blood and 19% fewer packed red blood cell (PRBC) units were transfused [54]. Another tertiary academic center inserted evidence-based decision support for RBC transfusion into the computerized physician order entry system.…”