Inelda Gjata1, Lori Olivieri2, Leyla Baghirzada2, Ryan V W Endersby2, Nathan M Solbak3, Colin G W Weaver4,5, Sampson Law1, Lara J Cooke6, Kelly W Burak1, Shawn K Dowling7. 1. Physician Learning Program, Continuing Medical Education and Professional Development, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada. 2. Department of Anesthesiology, Perioperative and Pain Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada. 3. Physician Learning Program, Continuing Medical Education and Professional Development, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada. nathan.solbak@ucalgary.ca. 4. Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada. 5. Health Services Statistical and Analytic Methods, Analytics, Alberta Health Services, Calgary, AB, Canada. 6. Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada. 7. Department of Emergency Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.
Abstract
PURPOSE: Intraoperative tranexamic acid (TXA) is used to reduce blood loss and the need for transfusions following total hip arthroplasty (THA) and total knee arthroplasty (TKA). Despite evidence in literature and local practice protocols supporting TXA as a part of standard of care for joint arthroplasty, TXA administration is underutilized. We aimed to use group-facilitated audit and feedback as the foundation of a knowledge translation strategy to increase TXA use for THA and TKA procedures. METHODS: Anesthesiologists consented to receive two data reports summarizing their individual rates of TXA use and postoperative blood transfusions compared with site peers. Variables collected included patient demographics, TXA usage, and the frequency and volume of red blood cell transfusions administered in the 72-hr postoperative period. The facilitated feedback session discussed report findings and focused on factors contributing to local practice patterns and opportunities for change. RESULTS: Tranexamic acid use increased for THA procedures at the intervention site from 66.6 to 74.4% (absolute change, 7.9%; 95% confidence interval [CI], 2.4 to 13.3). Likewise, TXA use for TKA procedures increased from 62.4 to 82.3% (absolute change, 19.9%; 95% CI 15.0 to 25.0). CONCLUSIONS: Physicians and their teams were able to review their practice data on TXA utilization, reflect on differences compared with evidence-based guidelines, discuss findings with peers, and identify opportunities for improvement. The intervention increased the use of TXA for both TKA and THA and shifted the dosage to better align with evidence-based practice guidelines.
PURPOSE: Intraoperative tranexamic acid (TXA) is used to reduce blood loss and the need for transfusions following total hip arthroplasty (THA) and total knee arthroplasty (TKA). Despite evidence in literature and local practice protocols supporting TXA as a part of standard of care for joint arthroplasty, TXA administration is underutilized. We aimed to use group-facilitated audit and feedback as the foundation of a knowledge translation strategy to increase TXA use for THA and TKA procedures. METHODS: Anesthesiologists consented to receive two data reports summarizing their individual rates of TXA use and postoperative blood transfusions compared with site peers. Variables collected included patient demographics, TXA usage, and the frequency and volume of red blood cell transfusions administered in the 72-hr postoperative period. The facilitated feedback session discussed report findings and focused on factors contributing to local practice patterns and opportunities for change. RESULTS: Tranexamic acid use increased for THA procedures at the intervention site from 66.6 to 74.4% (absolute change, 7.9%; 95% confidence interval [CI], 2.4 to 13.3). Likewise, TXA use for TKA procedures increased from 62.4 to 82.3% (absolute change, 19.9%; 95% CI 15.0 to 25.0). CONCLUSIONS: Physicians and their teams were able to review their practice data on TXA utilization, reflect on differences compared with evidence-based guidelines, discuss findings with peers, and identify opportunities for improvement. The intervention increased the use of TXA for both TKA and THA and shifted the dosage to better align with evidence-based practice guidelines.
Authors: Noah Ivers; Gro Jamtvedt; Signe Flottorp; Jane M Young; Jan Odgaard-Jensen; Simon D French; Mary Ann O'Brien; Marit Johansen; Jeremy Grimshaw; Andrew D Oxman Journal: Cochrane Database Syst Rev Date: 2012-06-13
Authors: Jared Warren; Kavin Sundaram; Hiba Anis; Atul F Kamath; Michael A Mont; Carlos A Higuera; Nicolas S Piuzzi Journal: J Am Acad Orthop Surg Date: 2020-03-01 Impact factor: 3.020