This Article  • Full text  • PDF  • Send to a friend  • Save in My Folder  • Save to citation manager  • Permissions  Citing Articles  • Citation map  • Citing articles on HighWire  • Citing articles on Web of Science (13)  • Contact me when this article is cited  Related Content  • Similar articles in this journal  Topic Collections  • Quality of Care, Other  • Review  • Hematology, Other  • Alert me on articles by topic  Social Bookmarking   What's this?

A Systematic Review of Behavioral Interventions to Change Physicians’ Transfusion Practices

Alan Tinmouth, MD; Laura MacDougall, MSc; Dean Fergusson, PhD; Mohammed Amin, PhD; Ian D. Graham, PhD; Paul C. Hebert, MD; Kumanan Wilson, MD

Arch Intern Med. 2005;165:845-852.

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.

Author Affiliations: Clinical Epidemiology Program, Ottawa Health Research Institute, Ottawa, Ontario (Drs Tinmouth, Fergusson, Amin, Graham, and Hebert and Ms MacDougall); University of Ottawa Center for Blood Research (Drs Tinmouth, Fergusson, Amin, Hebert, and Wilson); Faculties of Medicine (Drs Tinmouth, Fergusson, Amin, Graham, and Hebert and Ms MacDougall) and Health Sciences (Dr Graham), University of Ottawa, Ottawa; and Faculty of Medicine, University of Toronto, Toronto, Ontario (Dr Wilson).

CiteULike    Connotea    Del.icio.us    Digg    Reddit    Technorati    Twitter     What's this?

THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES

Blood conservation strategies to reduce the need for red blood cell transfusion in critically ill patients
Tinmouth et al.
CMAJ 2008;178:49-57.
ABSTRACT | FULL TEXT  

Coronary artery bypass graft surgery care globalization: The impact of national care on fatal and nonfatal outcome
Ott et al.
J. Thorac. Cardiovasc. Surg. 2007;133:1242-1251.
ABSTRACT | FULL TEXT