A Controlled Trial of Educational Outreach to Improve Blood Transfusion Practice

摘要: Objective. —To determine whether brief, face-to-face educational outreach visits can improve the appropriateness of blood product utilization. Design. —Randomized, controlled multicenter trial with 6-month follow-up. Setting. —Surgical and medical services two pairs matched community teaching hospitals in Massachusetts. Participants. —One hundred one transfusing staff surgeons attending physicians. Intervention. —A professionally based transfusion specialist presented surgical- or medical-service—wide lecture emphasizing appropriate indications, risks, benefits red cell transfusions; graphic, printed guidelines; 30-minute visit each physician. No data feedback was provided. Educational messages emphasized lack utility traditional threshold for transfusions (hematocrit, 30%) risks (eg, viral hepatitis). Measures. —Proportion classified as compliant noncompliant guidelines, indeterminate 6 months before after an experimental intervention. Results. —Based on analyses 1449 record audits that occurred intervention, average proportion not compliance criteria declined from 0.40 to 0.24 among study (-40%) compared increase 0.44 (+9%) control (P=.006). These effects were consistent across procedure type specialty. On average, postintervention period performed when hematocrits 2.0 percentage points lower than intervention (28.3% preintervention vs 26.3% postintervention), group postintervention;P=.04). Likely savings use surgical probably exceeded program costs, even without considering reduced infection. observed occurring services, possibly because substantially rates pretransfusion hematocrits. Conclusions. —Brief, focused by specialists cost-effectiveness surgery. More are needed regarding durability changes practice patterns health economic such interventions. (JAMA. 1993;270:961-966)