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Are we choosing wisely with blood use? An assessment of transfusion practice and attitudes
Researchers: Shoshana Revel-Vilk1, Hagit Hochner2, Mira Naamad3, Revital Saban1, Orly Zelig1
- Haddasah Medical Center
- The Hebrew University
- Shaare Zedek Medical Center
Background: Blood transfusions save lives; however, unnecessary transfusion practice exposes patients to negative consequences.
Objectives: Corresponding to the Choosing Wisely® ‘restrictive transfusion’ recommendations, this study aimed to assess
1. Red blood cell (RBC) transfusion practices by patient- and admission-related characteristics;
2. Atitudes of physicians towards transfusion practices.
1. Red blood cell (RBC) transfusion practices by patient- and admission-related characteristics;
2. Atitudes of physicians towards transfusion practices.
Method: A cross-sectional study of RBC transfusion practices and physicians' attitudes was conducted in departments with high volume of RBC use in three Jerusalem hospitals.
Findings: RBC transfusions: 584 RBC transfusions met inclusion criteria. These transfusions were given to 302 patients, aged 14-100 (mean 67±19.5) years, of which 53.6% were females. Prevalence of non-restrictive RBC transfusion practice, as defined in this study, was 48.8%. Non-restrictive practice was more common in older patients (67.8±18.2 vs. 60.7±21.8, OR=1.02;95%CI 1.01-1.03) and in surgical vs. non-surgical departments (OR=6.9;95%CI 3.3-14.1). Non-restrictive practice was less common among patients with pulmonary disease (OR=0.6, 95% CI 0.4-0.9) and more common in patients taking antithrombotic therapy (OR=1.5, 95% CI 1.03-2.2). Patients’ other underlying conditions and pre-transfusion signs were not associated with non-restrictive practice.
Physician's attitudes: 247 physicians participated in the survey (85% response), of which 68% stated they were familiar with the term ‘restrictive transfusion’. Seniors compared to interns/residents (OR=3.95;95%CI 2.09-7.47) and internists compared to surgeons (OR=2.35;95%CI 1.26-4.37) were more familiar with the term ‘restrictive transfusion’. However, familiarity with the term ‘restrictive transfusion’ was not associated with correct answers to transfusion practice questions. Physicians' responses to questions vary widely between different types of departments and seniority levels.
Physician's attitudes: 247 physicians participated in the survey (85% response), of which 68% stated they were familiar with the term ‘restrictive transfusion’. Seniors compared to interns/residents (OR=3.95;95%CI 2.09-7.47) and internists compared to surgeons (OR=2.35;95%CI 1.26-4.37) were more familiar with the term ‘restrictive transfusion’. However, familiarity with the term ‘restrictive transfusion’ was not associated with correct answers to transfusion practice questions. Physicians' responses to questions vary widely between different types of departments and seniority levels.
Conclusions: Nearly half of RBC transfusions are not given based on suggested guidelines. Our findings highlight the need to further our understanding of clinical decision-making leading to RBC transfusion.
Recommendations: This study calls for setting clear guidelines to facilitate wise transfusion-related choices and for uniformly disseminating guidelines among physicians. We recommend the integration of a patient blood management system, particularly in departments with high RBC utilization, aimed at reducing adverse events and direct costs of this invaluable resource.
Research number: A/80/2014
Research end date: 04/2017