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Optimizing red blood cell transfusion practices in the intensive care unit: a multi-phased health technology reassessment

Published online by Cambridge University Press:  20 December 2021

Lesley J.J. Soril
Affiliation:
Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Canada O'Brien Institute for Public Health, University of Calgary, Calgary, Canada
Tom W. Noseworthy
Affiliation:
Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Canada O'Brien Institute for Public Health, University of Calgary, Calgary, Canada
Derek R. Townsend
Affiliation:
Department of Critical Care Medicine, Faculty of Medicine and Dentistry, University of Alberta and Alberta Health Services, Edmonton, Canada
Sean M. Bagshaw
Affiliation:
Department of Critical Care Medicine, Faculty of Medicine and Dentistry, University of Alberta and Alberta Health Services, Edmonton, Canada
Henry T. Stelfox
Affiliation:
Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Canada O'Brien Institute for Public Health, University of Calgary, Calgary, Canada Department of Critical Care Medicine, Cumming School of Medicine, University of Calgary and Alberta Health Services, Calgary, Canada
David A. Zygun
Affiliation:
Department of Critical Care Medicine, Faculty of Medicine and Dentistry, University of Alberta and Alberta Health Services, Edmonton, Canada
Fiona M. Clement*
Affiliation:
Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Canada O'Brien Institute for Public Health, University of Calgary, Calgary, Canada
*
Author for correspondence: Fiona M. Clement, E-mail: fclement@ucalgary.ca

Abstract

Background

Health technology reassessment (HTR) is a process to manage existing health technologies to ensure ongoing optimal use. A model to guide HTR was developed; however, there is limited practical experience. This paper addresses this knowledge gap through the completion of a multi-phase HTR of red blood cell (RBC) transfusion practices in the intensive care unit (ICU).

Objective

The HTR consisted of three phases and here we report on the final phase: the development, implementation, and evaluation of behavior change interventions aimed at addressing inappropriate RBC transfusions in an ICU.

Methods

The interventions, comprised of group education and audit and feedback, were co-designed and implemented with clinical leaders. The intervention was evaluated through a controlled before-and-after pilot feasibility study. The primary outcome was the proportion of potentially inappropriate RBC transfusions (i.e., with a pre-transfusion hemoglobin of 70 g/L or more).

Results

There was marked variability in the monthly proportion of potentially inappropriate RBC transfusions. Relative to the pre-intervention phase, there was no significant difference in the proportion of potentially inappropriate RBC transfusions post-intervention. Lessons from this work include the importance of early and meaningful engagement of clinical leaders; tailoring the intervention modalities; and, efficient access to data through an electronic clinical information system.

Conclusions

It was feasible to design, implement, and evaluate a tailored, multi-modal behavior change intervention in this small-scale pilot study. However, early evaluation of the intervention revealed no change in technology use leading to reflection on the important question of how the HTR model needs to be improved.

Type
Assessment
Copyright
Copyright © The Author(s), 2021. Published by Cambridge University Press

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