Impact of Guideline Implementation on Transfusion Practices in a Surgical Intensive Care Unit

BACKGROUND: Anemia is a common clinical problem in cardiac surgery patients in the postoperative period and may result in transfusion in up to 90% of this population. There is tremendous variation in transfusion rates by hospital and individual physician. It is unknown if implementation of a clinical practice guideline lowers unnecessary transfusion in hospital practices that already have a restrictive transfusion culture .

OBJECTIVE:

To evaluate transfusion practice before and after implementation of a clinical practice guideline.

DESIGN:

Pre/post intervention study.

SETTING:

Sixteen bed surgical intensive care unit in an academic hospital.

PARTICIPANTS:

Four hundred ninety-five adult patients undergoing cardiac surgery.

INTERVENTIONS:

Implementation of an anemia clinical practice guideline reinforced with education and retrospective audit/feedback.

MEASUREMENTS AND MAIN RESULTS:

A total of 252 pre-intervention and 243 postintervention cases were examined. Unnecessary transfusion occurred in 14.7% of pre-intervention patients and decreased to a rate of 8.1% after guideline implementation (p = 0.016).

CONCLUSIONS:

This study suggests that clinical guideline implementation utilizing guideline development, education, and compliance audit/feedback may reduce unnecessary transfusion in cardiac surgery patients. A fully powered prospective trial would be necessary to validate these findings.