title: Reducing the amount of blood transfused: a systematic review of behavioral interventions to change physicians' transfusion practices.
abstract: BACKGROUND
  Transfusion services have used various techniques to reduce blood product utilization. Given the potential adverse effects of transfusions and the resources consumed in implementing strategies to reduce transfusions, there is a need to understand their effectiveness. Therefore, we performed a systematic review of the literature to examine the effectiveness of behavioral interventions to reduce blood product utilization.
  
  
  METHODS
  We identified all relevant articles through the use of electronic searches of MEDLINE and EMBASE, as well as hand searches of review articles and personal files. The electronic searches included articles published between January 1966 and May 2003. The searches included the terms blood transfusion, plasma exchange, guidelines, education, practice patterns, and professional practice. The outcomes of interest were the number of units transfused and the proportion of patients who received transfusions.
  
  
  RESULTS
  Nineteen studies examining the effectiveness of single (guidelines, prospective audits, retrospective audits, and reminders) or multifaceted interventions in reducing red blood cell, platelet, plasma, cryoprecipitate, and albumin transfusions met the inclusion criteria. Eighteen studies demonstrated a relative reduction in the number of units given (range, 9%-77%) or the proportion of patients receiving transfusions (range, 17%-79%). The reported reductions were qualitatively similar for the different blood products studied. No particular intervention or combination of interventions appeared more effective in reducing utilization.
  
  
  CONCLUSIONS
  Behavioral interventions, including simple interventions, appear to be effective in changing physician transfusion practices and reducing blood utilization. Appropriately designed clinical trials are still needed to determine the relative effectiveness of different interventions to change practices.
authors.affiliation: Clinical Epidemiology Program, Ottawa Health Research Institute, Ottawa, Ontario, Canada.
authors.forename: Alan
authors.initials: A
authors.lastname: Tinmouth
authors.forename: Laura
authors.initials: L
authors.lastname: Macdougall
authors.forename: Dean
authors.initials: D
authors.lastname: Fergusson
authors.forename: Mohammed
authors.initials: M
authors.lastname: Amin
authors.forename: Ian D
authors.initials: ID
authors.lastname: Graham
authors.forename: Paul C
authors.initials: PC
authors.lastname: Hebert
authors.forename: Kumanan
authors.initials: K
authors.lastname: Wilson
mesh_terms: D001519:Behavior; D001803:Blood Transfusion / Q000706:statistics & numerical data* / Q000639:trends; D006801:Humans; D010819:Physician's Role; D010820:Physicians / Q000592:standards*; D010818:Practice Patterns, Physicians' / Q000639:trends*; D012189:Retrospective Studies