Red blood cell ordering pattern following the introduction of a transfusion procedure based on haemoglobin concentration and anaemia symptoms: A retrospective study

Implementation of transfusion guidelines might be poor due to a lack of awareness and strong practice habits. The study aimed to evaluate the impact of a new guideline-based, locally adjusted transfusion procedure on physicians' ordering patterns in a large academic medical centre. The study was a single-centre, retrospective study, analyzing period between January 2022 and December 2023. The study period was divided into three phases according to the procedure introduction: pre-introduction (January 2022-June 2022), introduction (July 2022-December 2022) and post-introduction (January 2023-December 2023, subdivided into 6-month periods). The new procedure was aimed at adult non-bleeding patients. Data on red blood cell (RBC) transfusions were obtained from a blood bank inventory and electronic health records. The appropriateness of transfusions was assessed against the newly introduced RBC procedure. During the study period, 2413 out of 3686 (65.5%) RBCs were transfused for the indication of "anaemia". The number of transfused RBCs between 2022 and 2023 decreased by 467 (32.4%) units. The appropriateness of RBC transfusions increased from 53.6% in the pre-introduction phase to 79.1% by the end of the post-introduction phase. There was a decrease in median pre- and post-transfusion haemoglobin (Hb) concentration, from 73 (IQR 66-78) and 91 (IQR 80-99) to 67 (IQR 60-73) and 84 (IQR 75-93) g L-1, respectively. The post-introduction phase showed sustained improvement in the appropriateness of RBC transfusions. The newly implemented RBC transfusion procedure, based on haemoglobin concentration and anaemia symptoms, supported by specific transfusion indications integrated into the computerised physician order entry system, resulted in a significant decrease in transfusions and an increase in appropriate transfusions. This improvement was sustained in the long term.