Durability of response to a targeted intervention to modify clinician transfusion practices in a major teaching hospital.
OBJECTIVE
To determine the durability of a successful intervention to modify clinician transfusion practices, and to compare current transfusion practices in the "intervention" hospital with those in a hospital with no intervention.


METHODS
Prospective, descriptive study.


METHODS
Two major metropolitan teaching hospitals--Royal Melbourne Hospital and Western Hospital, Footscray.


METHODS
Consecutive patient transfusion episodes for red cells, platelets and fresh frozen plasma (FFP).


METHODS
Appropriateness of transfusion according to intervention guidelines; comparison of inappropriate transfusion rates before the intervention, immediately after the intervention and 3 years after the intervention. Comparison of inappropriate transfusion rates in intervention and non-intervention hospitals.


RESULTS
Inappropriate transfusion rates 3 years after the intervention were 20% for red cells, 27% for platelets, and 43% for FFP. These were significantly higher than equivalent rates reported immediately after the intervention. Inappropriate transfusion rates at the non-intervention hospital were comparable (26% for red cells, 36% for platelets and 52% for FFP).


CONCLUSIONS
Appropriate clinician transfusion practices have proven difficult to sustain 3 years after hospital guideline generation and promotion. A "gate-keeping" role by hospital blood bank staff proved impractical in the long term.
Tobin
S N
SN
Clinical Epidemiology and Health Service Evaluation Unit, NorthWestern Health Care Network, Melbourne, VIC.
Campbell
D A
DA
Boyce
N W
NW
D001315:Australia; D016913:Blood Component Transfusion; D019983:Guideline Adherence; D006784:Hospitals, Teaching; D006801:Humans; D017410:Practice Guidelines as Topic; D011446:Prospective Studies