title: Adherence to transfusion guidelines: are we prepared for the Smarter Medicine or Choosing Wisely initiative?
abstract: OBJECTIVE
  To determine, whether a restrictive transfusion strategy is followed in our hospital and to identify differences in activities within departments and patient groups.
  
  
  METHODS
  Over a period of 15 months, RBC transfusions were prospectively recorded including the haemoglobin level prior to transfusion and were grouped in the different departments of our hospital (internal medicine ward, department of surgery, emergency room, intensive care unit, gynaecology ward, medical outpatient clinic and oncology outpatient clinic). Indications and co-morbidities were assessed retrospectively by reviewing the patient's charts.
  
  
  RESULTS
  There were 1,832 RBC products transfused in total. The overall mean level of haemoglobin before transfusion was 7.61 g/dl (±1.1). These haemoglobin levels differed significantly between the departments (p <0.001), with the lowest threshold in the internal medicine ward (7.30 g/dl ± 1.0) compared to the surgery ward (7.73 g/dl ± 1.0) and to the intensive care unit (7.82 g/dl ± 0.9). In general, mean pre-transfusion haemoglobin levels did not differ significantly between patients with coronary artery disease (CAD) and patients without (7.64 g/dl ± 1.0 vs 7.59 g/dl ± 1.1, p = 0.48). In transfusions for patients with acute coronary syndrome a tendency to a higher transfusion threshold than in patients with stable CAD could be found (7.84 g/dl ± 0.7 vs 7.58 g/dl ± 1.0, p = 0.05). Patients with haematological disorders were transfused at a higher threshold when compared to patients without (7.77 g/dl vs 7.56 g/dl, p = 0.006).
  
  
  CONCLUSIONS
  All wards in our analysis are following the current guidelines based on restrictive transfusion strategies. At the same time, we were able to detect significant differences between different departments and patient characteristics.
authors.affiliation: Medical Clinic, Uster Hospital, Uster, Switzerland.
authors.forename: Bernard
authors.initials: B
authors.lastname: Surial
authors.affiliation: Medical Clinic, Uster Hospital, Uster, Switzerland.
authors.forename: Andreas
authors.initials: A
authors.lastname: Burkhart
authors.affiliation: Medical Clinic, Uster Hospital, Uster, Switzerland.
authors.forename: Nicolas
authors.initials: N
authors.lastname: Terliesner
authors.affiliation: Medical Clinic, Uster Hospital, Uster, Switzerland.
authors.forename: Martina
authors.initials: M
authors.lastname: Morgenthaler
authors.affiliation: Medical Clinic, Uster Hospital, Uster, Switzerland.
authors.forename: Esther
authors.initials: E
authors.lastname: Bächli
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001803:Blood Transfusion / Q000592:standards*; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data; D005260:Female; D019983:Guideline Adherence / Q000706:statistics & numerical data*; D006454:Hemoglobins / Q000032:analysis; D006748:Hospital Departments / Q000706:statistics & numerical data*; D006764:Hospitals, Community; D006801:Humans; D007362:Intensive Care Units / Q000706:statistics & numerical data; D007388:Internal Medicine / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D009775:Obstetrics and Gynecology Department, Hospital / Q000706:statistics & numerical data; D016522:Oncology Service, Hospital / Q000706:statistics & numerical data; D010044:Outpatient Clinics, Hospital / Q000706:statistics & numerical data; D011446:Prospective Studies; D012189:Retrospective Studies; D012955:Societies, Medical / Q000592:standards; D013503:Surgery Department, Hospital / Q000706:statistics & numerical data; D013557:Switzerland; D014481:United States
chemical_list: D006454:Hemoglobins