null Training physicians to improve blood transfusion safety and pertinence: a successful strategy
Rates in blood transfusions have decreased at the MUHC following the implementation of an educational intervention, shows a new study by RI-MUHC researchers.
A new article published in JAMA Network Open by a team of researchers at the Research Institute of the McGill University Health Centre (RI-MUHC) shows that a quality-improvement intervention implemented in 2019 to increase transfusion safety and appropriateness at the McGill University Health Centre (MUHC) was associated with an immediate-level drop in blood transfusions rates.
“Blood transfusions are a lifesaving but limited resource. Over the past decade, many studies have shown that it is safe to limit the amount of blood we transfuse and that it leads, in some cases, to as good or better patient outcomes,” says the corresponding author of the study, Dr. Emily McDonald, an internist at the MUHC and a scientist in the Infectious Diseases and Immunity in Global Health (IDIGH) Program at the RI-MUHC, who worked with the associate director of Education for the MUHC, Michel Sergerie, on a plan to deploy the intervention. “It is vital that we train our next generation of physicians on safe and appropriate use of transfusions to appropriately allocate this resource and improve patient care.”
In this study, the researchers report on the impact of an educational initiative for resident physicians that consisted of a 15-minute presentation on the importance of hemovigilance and an online training module. The training highlighted the risks that unnecessary blood transfusions can pose for patients—like bacterial infection, allergic reaction, water on the lungs, and acute lung injury (or inflammation of the lungs)—and the fact that blood products are a precious resource available in limited quantities.
The researchers compared blood transfusion rates before and after the implementation of the intervention on medical and surgical units, as well as obstetrics and cardiology units, and observed a decrease of -1.96 transfusion per 1,000 patient days. Patient days are the total number of days spent in hospital by patients. For instance, 1,000 patient days could correspond to the total number of days of hospitalization of 100 patients staying 10 days on a given care unit.
This reduction in blood transfusions is an important step forward, in terms of not only patient care and safety, but also financially.
“In Canada a blood transfusion costs about $500, mainly in human resources. If we save an average of two transfusions per 1,000 patient days, we are saving $1,000 per 1,000 patient days,” explains Dr. McDonald, who is also an associate professor in the Department of Medicine at McGill University. “In the MUHC units included in our study, the total estimated patient days per year was 286,000, so we saved about $286,000 a year with the intervention. Based on this calculation, the savings could account for one million dollars over four years if the same reductions continued over time.”
“While all residents technically get some form of transfusion safety information during training, this online teaching module is more comprehensive, interactive, and specifically addresses indications and management of transfusion reactions,” says the first author of the study, Dr. Todd C. Lee, who is a scientist in the IDIGH program at the RI-MUHC and who was the director of the MUHC Clinical Teaching Unit (CTU) when the project was initiated. “The time our trainees invested in this learning activity strengthened their education and improved the management and proper use of blood products at the hospital level. This would never have been possible without their good will and the CTU and medical education leadership agility.”
About the study
The study Comparison of Blood Transfusion Rates Before and After Implementation of a Quality Improvement Initiative for Transfusion Safety and Appropriateness was conducted by Todd C. Lee, Nisha Almeida, Patricia Pelletier and Emily G. McDonald
January 27, 2023