(1306) Encouraging Conservative Transfusion Strategies of Blood in Critically Ill Patients

Introduction: Multiple studies in diverse patient populations have demonstrated that conservative transfusion strategies are non-inferior, if not superior, to liberal transfusion strategies. Accordingly, the ABIM choosing wisely guidelines recommend single unit transfusions in nonbleeding critically ill patients. However, in practice, adherence to restrictive transfusion practices may be highly variable and the impact of specific educational and feedback approaches to encourage this, has not been described. We have produced a simple critical care provider education approach that effectively encourages restrictive transfusion.

Methods: Provider level transfusion data [patients transfused, total red blood cells (RBCs) transfused, percent 1 unit RBC orders, and pre-transfusion hemoglobin] has been collected on our critical care workforce (total 30 providers) every 6 months since January 2020. Transfusion frequency is normalized for provider workload (shifts worked). Beginning in August 2020, the entire provider group has been presented biannually with non-anonymized provider level data and reminded of the literature supporting the superiority of restrictive transfusion practices.

Results: This program has reduced both the frequency of RBC transfusion and the practice variability around transfusion from 0.47 ± 0.30 in 2020 to 0.37 ± 0.14 in 2023 (units RBC transfused per shift ± standard deviation). In addition, the frequency of single unit transfusions has risen from 62% in 2020 to 85% in 2023.

Conclusions: Simple, regular, non-anonymized feedback to critical care providers can reduce transfusion frequency, inter-provider practice variability, and compliance with single unit transfusion practice. This should be associated with an overall decrease in blood product usage and reduced cost.