An Active Intervention Has Reduced RBC Transfusion Number: A Single Center Expierience

Background: "Choosing wisely" strategies have been applied in Tel Aviv Sourasky Medical Center (TASMC). Limiting red blood cell (RBC) transfusions according to the 1999/2005 guidelines, without compromising patient care, has been selected as a major goal. Our preliminary single center experience is described.

Methods: We initiated a program including physician education, inspection and feedback. We retrospectively reviewed the inpatient charts and the hospital RBC transfusion data from 2011-2015.

Results: Approximately 80,000 non-surgical patients are admitted yearly to TASMC, primarily to the Department of Medicine (350 beds). The percentage of transfused patients declined from 4.6% in 2011 to 4.2% in 2013. Most transfused patients were older than 80 years with cardiovascular disease or other co-morbidities. The % of patients requiring RBC transfusions who had pre-transfusion Hb ≥ 9 g/dL was reduced from 23.8% (2011) to 21.9% (2012) and 14.4% (2013). Those with pre-transfusion Hb ≥ 8g/dL declined from 62.9% (2011) to 59.6% (2012) and 51.8% (2013). The total number of RBC units transfused declined from 2982 in 2012 to 2404 in 2015, a 19.4% reduction.

Summary: An active policy including education, awareness, and feedback from blood bank to physician, using a lower Hb threshold, resulted in a dramatic reduction of RBC transfusions.