title: Transfusion insurgency: practice change through education and evidence-based recommendations.
abstract: BACKGROUND
  In 2000, we implemented an evidence-based guideline in the surgical intensive care unit (SICU) using a transfusion threshold of hemoglobin <8 g/dL. We hypothesized that continual education on the transfusion protocol would decrease transfusions.
  
  
  METHODS
  We analyzed 2-month samples of admissions in even-numbered years from 1998 to 2006. Any infusion of packed red blood cells (PRBCs) was included.
  
  
  RESULTS
  We analyzed data from 2,138 patients resulting in 5,130 transfusions. Thirty-six patients received >20 U of blood. The only difference between groups occurred in 2006 when renal failure increased. Transfusions decreased from 3.2 +/- 0.34 (SE) to 1.7 +/- 0.2. The number of patients who received blood also decreased. Mortality and length of stay (LOS) were not different among the groups. Every unit of blood transfused increased the mortality risk by 14%.
  
  
  CONCLUSIONS
  Implementation of an evidence-based transfusion guideline reduced the number of infused units and patients transfused without an increase in mortality.
authors.affiliation: Department of Surgery, Henry Ford Hospital, Detroit, MI, USA. mbrandt1@hfhs.org
authors.forename: Mary-Margaret
authors.initials: MM
authors.lastname: Brandt
authors.forename: Ilan
authors.initials: I
authors.lastname: Rubinfeld
authors.forename: Jack
authors.initials: J
authors.lastname: Jordan
authors.forename: Dhaval
authors.initials: D
authors.lastname: Trivedi
authors.forename: H Mathilda
authors.initials: HM
authors.lastname: Horst
mesh_terms: D000328:Adult; D000368:Aged; D000740:Anemia / Q000628:therapy; D003422:Critical Care; D017707:Erythrocyte Transfusion / Q000401:mortality; D005260:Female; D006454:Hemoglobins; D006801:Humans; D008297:Male; D008875:Middle Aged; D017410:Practice Guidelines as Topic; D011364:Professional Practice; D012189:Retrospective Studies
chemical_list: D006454:Hemoglobins