A comprehensive Choosing Wisely quality improvement initiative reduces unnecessary transfusions in an Academic Department of Surgery

Background: We implemented a comprehensive Choosing Wisely initiative to reduce unnecessary transfusions in an Academic Department of Surgery.

Methods: We conducted a survey- and lecture-based educational intervention to increase awareness about published transfusion guidelines. Monthly transfusion reports were subsequently distributed to all faculty, fellows, residents, and mid-level practitioners. Blood utilization measures were compared pre- vs. post-intervention to assess effectiveness.

Results: 7994 blood product orders (5388 pre-intervention, 2606 post-intervention) were placed (07/2014-06/2016). Red blood cell (RBC) (45% vs. 55%; P < 0.001) and plasma (68% vs. 75%; P = 0.02) compliance improved post-intervention, with a corresponding 15% decrease in RBC utilization (0.47 ± 0.02 vs. 0.40 ± 0.02 units/patient; P = 0.01), and 24% decrease in plasma (0.25 ± 0.02 vs. 0.19 ± 0.02 units/patient; P = 0.06). These reductions translate into $125,558 in blood product acquisition cost avoidance (RBC = $114,386, plasma = $11,172).

Conclusions: Implementation of a comprehensive Choosing Wisely campaign targeting individual providers at all levels significantly improved transfusion practices and decreased costs within the Department of Surgery.