Reduction in red blood cell transfusion associated with engagement of the ordering physician.

This is a single-centre retrospective analysis from Rhode Island reporting the results of an active involvement of the blood bank in discouraging liberal transfusion behaviour by consultation between 1998 and 2012. Prescriptions (orders) for RBCs were screened for pretransfusion haemoglobin levels in non-bleeding patients. By phone contact to the ordering physician, pretransfusion haemoglobin levels of more than 9 g/dL were recommended for cancellation. Levels between 8 and 9 g/dL advised for a single unit, if 2 or more units were requested. RBC transfusion rates showed an approximate 33% decrease, not paralleled by a decrease in overall patient volume. The change was slow and became significant after a 6-year learning period. Inpatient mortality rates declined over this period.

This is a good example of interdisciplinary cooperation managed by blood bank technicians. The programme does require the active involvement of a physician who is knowledgeable in the transfusion medicine literature to encourage and provide support to the technologists who engage the physicians. Physicians became more aware that requests for RBCs (and other components) may be questioned by the blood bank, causing the physician to exercise reserve in RBC prescriptions. As opposed to software solutions that might be bypassed easily, this way of quality improvement for blood product use is best — it is engagement, it is personal, it is communication and cooperation.

– Thomas Frietsch

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