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.
Keywords: anemia; cardiac surgery; guideline; quality improvement; transfusion.
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