PS1587 EDUCATIONAL INTERVENTION ENCOURAGING APPROPRIATE USE OF BLOOD TRANSFUSIONS – EXTENDED FOLLOW UP AND COMPARATIVE STUDY
Authors: Pasvolsky O. , Shepshelovich D. , Berger T. , Tadmor B. , Shochat T. , Raanani P. , Yahalom V. , Gafter‐Gvili A. 
Published: June 2019

Background:

Restrictive transfusion strategy of packed red blood cells (PRBCs) has been shown to improve patient outcomes in a variety of clinical settings. Various educational measures have been shown to improve short‐term appropriateness of PRBC transfusions.

Aims:

The aim of the present study was to examine the long‐lasting effects of a simple and low‐cost educational intervention aimed to promote awareness to current transfusion guidelines.

Methods:

Our medical center is composed of 2 campuses. During December 2014 we conducted an educational intervention which included an oral presentation to all non‐intensive care departments in the larger of the two campuses, Campus#1. In order to assess the long term effects of the intervention, we retrospectively analyzed all PRBC transfusions ordered in non‐critical care inpatient services between 2014 and 2017 in both campuses. Data regarding measured hemoglobin (Hb) preceding transfusions were collected. The primary end‐point was defined as the percentage of PRBC transfused to patients with Hb ≥ 8 g/dl in the years 2015–2017 compared to that transfused in 2014. Secondary end‐points were the percentage of PRBC transfused to patients with Hb < 7 g/dl and the total number of PRBC transfused during 2015–2017 compared to 2014. We further evaluated transfusion appropriateness in Campus#1 compared to Campus#2.

Results:

Between January 2014 and December 2017, a total of 35,575 PRBC were transfused at our medical center, 27,475 at Campus#1 and 8,100 at Campus#2. There was a statistically significant and continuous reduction in the percentage of PRBC transfused at a Hb ≥ 8 g/dl in Campus#1 between 2014 and 2017, with a matching increase in the percentage of PRBC transfused at Hb under 7 g/dL [OR reduction of 42% (CI 0.54–0.62) and OR increase of 68% (CI 1.56–1.81), respectively]. The total number of PRBC transfusions in Campus#1 demonstrated a statistically significant gradual annual decrease from 2014 (N = 7967) to 2017 (N = 6022), (p < 0.0001). This decrease was evident in most wards, except for obstetrics and gynecology (OB‐GYN). Compared to patients at Campus#1, patients in Campus#2 were more likely to receive a PRBC transfusion at a Hb level of 8 g/dL or above (p < 0.0001; Figure 1), and less likely to receive a PRBC transfusion at a Hb level below 7 g/dL (p < 0.0001) during the study period. Furthermore, in Campus#1 there was a gradual and statistically significant decrease in the PRBC transfusions ordered without Hb measurement during the day before administration, from 7.2% (N = 574) in 2014, to 5% (N = 305) in 2017 (p < 0.0001). This trend was not observed in campus #2.

Summary/Conclusion:

Our study suggests that a simple, cheap and easily implemented educational intervention can result in long‐term significant improvement in the appropriateness of PRBC transfusions. Medical centers should consider implementing similar interventions to improve appropriate PRBC transfusion.

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