Does training make a difference? Proficiency training in transfusion guidelines and its effect on red blood cell administration

Abstract

Background: Packed red blood cell (RBC) transfusion is a very common and frequently lifesaving therapeutic intervention, but a liberal transfusion policy may be associated with inferior patient outcomes. Various guidelines have been proposed to reduce the rate of unnecessary RBC transfusions. However, physicians' proficiency in such guidelines and the effect of training on RBC administration remain unknown.

Methods: We performed a questionnaire-based assessment of physicians' knowledge of the guidelines in a tertiary hospital in Israel, followed by an analysis of RBC administration six months before and six months after training was delivered.

Results: The level of proficiency was higher among Israeli university graduates (Odds Ratio [OR] 2.59, p-value = 0.02), internists (OR 2.8, p-value = 0.02), and physicians beyond the step-one residency exam (OR 3.08, p-value = 0.02). There was no significant effect of training on the rates of RBC administration (incidence rate ratio [IRR] = 0.96 [CI 95% 0.81-1.14], p-value = 0.655).

Conclusion: Educational intervention alone is an ineffective means of reducing the rates of RBC administration. A more complex approach is required to prevent unnecessary RBC transfusions.

Keywords: blood transfusion; clinical decision support; transfusion guidelines.