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

Introduction: 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.

Materials and methods: 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.

Results: 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.

Conclusions: 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.