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.


METHODS
Pre/post intervention study.


METHODS
Sixteen bed surgical intensive care unit in an academic hospital.


METHODS
Four hundred ninety-five adult patients undergoing cardiac surgery.


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


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.
School of Medicine, Department of Anesthesiology and Critical Care, The University of Pennsylvania, Philadelphia, PA. Electronic address: jacob.gutsche@uphs.upenn.edu.
Jacob T
JT
Gutsche
Zev Noah
ZN
Kornfield
Rebecca M
RM
Speck
Prakash A
PA
Patel
Pavan
P
Atluri
John G
JG
Augoustides
D000368:Aged; D000465:Algorithms; D000740:Anemia / Q000628:therapy; D001803:Blood Transfusion / Q000592:standards*; D006348:Cardiac Surgical Procedures; D002315:Cardiopulmonary Bypass; D003422:Critical Care / Q000592:standards*; D017707:Erythrocyte Transfusion / Q000592:standards; D005260:Female; D019983:Guideline Adherence; D006801:Humans; D007362:Intensive Care Units / Q000458:organization & administration / Q000592:standards*; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000628:therapy; D011446:Prospective Studies; D012189:Retrospective Studies; D019564:Unnecessary Procedures / Q000706:statistics & numerical data
anemia; cardiac surgery; guideline; quality improvement; transfusion