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. DESIGN: Pre/post intervention study. SETTING: Sixteen bed surgical intensive care unit in an academic hospital. PARTICIPANTS: Four hundred ninety-five adult patients undergoing cardiac surgery. INTERVENTIONS: Implementation of an anemia clinical practice guideline reinforced with education and retrospective audit/feedback. MEASUREMENTS AND MAIN 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.
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. DESIGN: Pre/post intervention study. SETTING: Sixteen bed surgical intensive care unit in an academic hospital. PARTICIPANTS: Four hundred ninety-five adult patients undergoing cardiac surgery. INTERVENTIONS: Implementation of an anemia clinical practice guideline reinforced with education and retrospective audit/feedback. MEASUREMENTS AND MAIN 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.
Authors: Anton Camaj; Darin B Zahuranec; Gaetano Paone; Barbara R Benedetti; Warren D Behr; Marc A Zimmerman; Min Zhang; Robert S Kramer; Jason Penn; Patricia F Theurer; Theron A Paugh; Milo Engoren; Alphonse DeLucia; Richard L Prager; Donald S Likosky Journal: Anesth Analg Date: 2017-09 Impact factor: 5.108
Authors: Katherine M Steffen; Scot T Bateman; Stacey L Valentine; Sara Small; Philip C Spinella; Allan Doctor Journal: Pediatr Crit Care Med Date: 2018-09 Impact factor: 3.624
Authors: Elliott D Kozin; Brian M Cummings; Derek J Rogers; Brian Lin; Rosh Sethi; Natan Noviski; Christopher J Hartnick Journal: JAMA Otolaryngol Head Neck Surg Date: 2015-01 Impact factor: 6.223
Authors: David C Fitzgerald; Annie N Simpson; Robert A Baker; Xiaoting Wu; Min Zhang; Michael P Thompson; Gaetano Paone; Alphonse Delucia; Donald S Likosky Journal: J Thorac Cardiovasc Surg Date: 2020-05-13 Impact factor: 5.209
Authors: Kaspar F Bachmann; Christian Vetter; Lars Wenzel; Christoph Konrad; Andreas P Vogt Journal: J Med Internet Res Date: 2019-08-15 Impact factor: 5.428
Authors: Lesley J J Soril; Thomas W Noseworthy; Laura E Dowsett; Katherine Memedovich; Hannah M Holitzki; Diane L Lorenzetti; Henry Thomas Stelfox; David A Zygun; Fiona M Clement Journal: BMJ Open Date: 2018-05-18 Impact factor: 2.692