A controlled trial of educational outreach to improve blood transfusion practice
S. B. Soumerai, S. Salem-Schatz, J. Avorn, C. S. Casteris, D. Ross-Degnan and M. A. Popovsky
Department of Social Medicine, Harvard Medical School, Boston, MA 02115.
OBJECTIVE--To determine whether brief, face-to-face educational outreach
visits can improve the appropriateness of blood product utilization.
DESIGN--Randomized, controlled multicenter trial with 6-month follow-up.
SETTING--Surgical and medical services of two pairs of matched community
and teaching hospitals in Massachusetts. PARTICIPANTS--One hundred one
transfusing staff surgeons and attending medical physicians.
INTERVENTION--A professionally based transfusion specialist presented one
surgical- or medical-service-wide lecture emphasizing appropriate
indications, risks, and benefits of red blood cell transfusions; brief,
graphic, printed educational guidelines; and one 30-minute visit with each
transfusing physician. No data feedback was provided. Educational messages
emphasized the lack of utility of the traditional threshold for red blood
cell transfusions (hematocrit, 30%) and transfusion risks (eg, viral
hepatitis). MEASURES--Proportion of red blood cell transfusions classified
as compliant or noncompliant with blood transfusion guidelines, or
indeterminate 6 months before and 6 months after an experimental
educational intervention. RESULTS: Based on analyses of 1449 medical record
audits of red blood cell transfusions that occurred 6 months before and 6
months after the educational intervention, the average proportion of
transfusions not in compliance with criteria declined from 0.40 to 0.24
among study surgeons (-40%) compared with an increase from 0.40 to 0.44
(+9%) among control surgeons (P = .006). These effects were consistent
across procedure type and specialty. On average, study surgeons in the
postintervention period performed transfusions when hematocrits were 2.0
percentage points lower than before the intervention (28.3% preintervention
vs 26.3% postintervention), and lower than in the control group (28.3%
preintervention and postintervention; P = .04). Likely savings in blood use
for surgical services probably exceeded program costs, even without
considering reduced risks of infection. No effects were observed among
transfusions occurring in medical services, possibly because of
substantially lower transfusion rates and lower pretransfusion hematocrits.
CONCLUSIONS--Brief, focused educational outreach visits by transfusion
specialists can substantially improve the appropriateness and
cost-effectiveness of blood product use in surgery. More data are needed
regarding the durability of changes in practice patterns and the health and
economic benefits of such interventions.
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Weingarten
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