The Implementation of a Red Blood Cell Transfusion Guideline in Critically Ill Surgical Patients at Siriraj Hospital

Abstract

Objective: To compare the RBC transfusion rate and clinical outcomes before and after the implementation of a
transfusion guideline and to determine the adherence rate to the guideline.
Methods: This is a prospective experimental study in adult patients (≥18 years) admitted to surgical intensive care
units. After developing and implementing a transfusion guideline, the data including patients’ characteristics,
transfusion and outcomes were collected prospectively (post-educational group). Data in pre-educational group
was retrieved retrospectively from medical records.
Results: There were 197 patients in pre-educational group and 188 patients in post-educational group. The incidence
of RBC transfusion significantly decreased significantly in post-educational group (37.2% vs. 48.7%, p = 0.02). The
hemoglobin threshold for RBC transfusion was significantly lower in post-education group (8.16±1.43 vs. 8.97±1.57,
p=0.001). The 28-day mortality rate was significantly decreased after the implementation of the guideline. (3.2 %
vs. 11.2 %, p = 0.007). The adherence rate to transfusion guideline was reported as 47.1%.
Conclusion: The incidence of RBC transfusion was lower after the implementation of a transfusion guideline.