A CONTROLLED TRIAL OF EDUCATIONAL OUTREACH TO IMPROVE BLOOD-TRANSFUSION PRACTICE

Objective.-To determine whether brief, face-to-face educational outrea ch 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 co mmunity and teaching hospitals in Massachusetts. Participants.-One hun dred 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 wit h each transfusing physician. No data feedback was provided. Education al messages emphasized the lack of utility of the traditional threshol d for red blood cell transfusions (hematocrit, 30%) and transfusion ri sks (eg, viral hepatitis). Measures.-Proportion of red blood cell tran sfusions classified as compliant or noncompliant with blood transfusio n guidelines, or indeterminate 6 months before and 6 months after an e xperimental educational intervention. Results.-Based on analyses of 14 49 medical record audits of red blood cell transfusions that occurred 6 months before and 6 months after the educational intervention, the a verage proportion of transfusions not in compliance with criteria decl ined from 0.40 to 0.24 among study surgeons (-40%) compared with an in crease from 0.40 to 0.44 (+9%) among control surgeons (P=.006). These effects were consistent across procedure type and specialty. On averag e, study surgeons in the postintervention period performed transfusion s when hematocrits were 2.0 percentage points lower than before the in tervention (28.3% preintervention vs 26.3% postintervention), and lowe r than in the control group (28.3% preintervention and postinterventio n; P=.04). Likely savings in blood use for surgical services probably exceeded program costs, even without considering reduced risks of infe ction. No effects were observed among transfusions occurring in medica l services, possibly because of substantially lower transfusion rates and lower pretransfusion hematocrits. Conclusions.-Brief, focused educ ational outreach visits by transfusion specialists can substantially i mprove 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 inte rventions.