Challenging blood transfusion practice: effect of targeted behavioural intervention on red cell transfusion in a district general hospital.

Abstract

Existing evidence shows that restrictive blood transfusion is safe and may avert potential harm associated with more liberal transfusion strategies. A significant number of patients are being both unnecessarily transfused and over-transfused for their age, diagnosis and comorbidities. We describe the implementation of a behavioural strategy through educational sessions and the provision of individualised patient-centred advice, offering haematinic investigation and supplementation where appropriate. We compared our interventional data with a retrospective analysis of patients receiving blood transfusion for number of units transfused, haemoglobin triggers and incidence of haematinic investigations. The data were also analysed for patient length of stay and cost effectiveness. There was a significant reduction in the number of red cell units transfused across all specialties (p=0.003). In total, 431 units were transfused in the interventional group compared with 571 in the control group. There was a significant reduction in over-transfusion (p=0.003). Patients undergoing haematinic testing increased by 16.6% (p=0.0002). There was no change in length of hospital stay and our strategy has been shown to not only be cost effective, but provide significant monetary saving. Our patient-centred approach, through clinician engagement and challenging outdated behaviours, has been shown to significantly reduce inappropriate blood transfusions.