title: Three-year follow-up of implementation of evidence-based transfusion practice in a tertiary hospital.
abstract: OBJECTIVE
  Traditionally, Denmark has had a high rate of allogeneic red blood cell transfusion caused by a liberal transfusion practice despite the existence of restrictive guidelines. We established a Patient Blood Management programme in a tertiary hospital and report the results of the implementation of evidence-based transfusion practice.
  
  
  METHODS
  Red blood cell transfusion quality indicators were compared with the evidence-based guideline at hospital and department level. Based on this evaluation, wards were selected for interventions targeting doctors and nurses. The implementation process was monitored by transfusion quality and utilization data over a 3-year period with totally 166 341 admissions in 98 960 mixed, adult medical and surgical patients.
  
  
  RESULTS
  At the hospital level, transfusion above the upper guideline limit decreased from 23 to 10% (P < 0·001), and transfusion at or below the restrictive haemoglobin trigger of 7·3 g/dl increased from 7 to 19% (P < 0·001). The percentage of single-unit transfusions increased from 72 to 78% (P < 0·001), and the majority of transfusion rates and volumes decreased significantly. Red cell use decreased with 41% in surgical procedures and 28% in admissions (P < 0·001).
  
  
  CONCLUSIONS
  The intervention was associated with a significant and sustained overall increase in compliance with national guidelines for red blood cell transfusion for non-bleeding patients, and led to significantly fewer patients being exposed to transfusion.
authors.affiliation: Section for transfusion medicine, Capital Region Blood Bank, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.
authors.forename: A
authors.initials: A
authors.lastname: Norgaard
authors.affiliation: Section for transfusion medicine, Capital Region Blood Bank, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.
authors.forename: J
authors.initials: J
authors.lastname: Stensballe
authors.affiliation: Section for transfusion medicine, Capital Region Blood Bank, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.
authors.forename: T H
authors.initials: TH
authors.lastname: de Lichtenberg
authors.affiliation: Department of intensive care, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.
authors.forename: J O
authors.initials: JO
authors.lastname: White
authors.affiliation: Department of intensive care, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.
authors.forename: A
authors.initials: A
authors.lastname: Perner
authors.affiliation: Department of thoracic anaesthesiology and intensive care, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.
authors.forename: M
authors.initials: M
authors.lastname: Wanscher
authors.affiliation: Department of abdominal surgery, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.
authors.forename: J
authors.initials: J
authors.lastname: Hillingsø
authors.affiliation: Department of urology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.
authors.forename: M L
authors.initials: ML
authors.lastname: Holm
authors.affiliation: Department of oncology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.
authors.forename: M
authors.initials: M
authors.lastname: Mau-Sørensen
authors.affiliation: Department of vascular surgery, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.
authors.forename: H
authors.initials: H
authors.lastname: Sillesen
authors.affiliation: Department of haematology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.
authors.forename: L
authors.initials: L
authors.lastname: Kjeldsen
authors.affiliation: Department of thoracic surgery, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.
authors.forename: C
authors.initials: C
authors.lastname: Bäck
authors.affiliation: Section for transfusion medicine, Capital Region Blood Bank, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.
authors.forename: J
authors.initials: J
authors.lastname: Nielsen
authors.affiliation: Section for transfusion medicine, Capital Region Blood Bank, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.
authors.forename: J
authors.initials: J
authors.lastname: Seeberg
authors.affiliation: Section for transfusion medicine, Capital Region Blood Bank, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.
authors.forename: M B
authors.initials: MB
authors.lastname: Hansen
authors.affiliation: Section for transfusion medicine, Capital Region Blood Bank, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.
authors.forename: P I
authors.initials: PI
authors.lastname: Johansson
mesh_terms: D000328:Adult; D016208:Databases, Factual; D003718:Denmark; D017707:Erythrocyte Transfusion; D055317:Evidence-Based Practice; D005260:Female; D005500:Follow-Up Studies; D006454:Hemoglobins / Q000032:analysis; D006801:Humans; D007362:Intensive Care Units; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D062606:Tertiary Care Centers
chemical_list: D006454:Hemoglobins
keywords: RBC transfusion; Transfusion practices (adult); blood management