438 Packed Red Cell Transfusion in Acute Surgical Patients, Are We Over-Transfusing?

Abstract

Abstract Aim To improve a general surgical department's adherence to NICE guidelines on transfusion of packed red cells for low haemoglobin by improving knowledge of relevant haemoglobin thresholds (70g/L or 80g/L in ACS or renal failure requiring chronic transfusion). Method All patients admitted to a large London teaching hospital under the general surgical team in a 4-month period (2020–2021) were audited using their electronic records. Audited data was units transfused; pre-transfusion haemoglobin, heart rate, and blood pressure; pertinent medical history; and location of transfusion (ward/theatre). 10 patients were excluded due to being transfused perioperative or because of haemodynamic instability (covered under different guidelines). 16 patients and a total of 31 units were included in the audit. The interventions were 1) distribution of a poster showing the NICE guideline, reasoning for the guideline, and baseline data; and 2) a teaching session for junior doctors (FY1 to registrar). Results The proportion of transfusions adhering to guidelines increased from 33% (6/18) at baseline to 60% (3/5) after intervention 1 and 100% (8/8) after intervention 2. The combined post-intervention score of 85% (11/13) was statistically significant compared to the baseline (p=0.013). Conclusions Acute surgical patients were frequently over-transfused with packed red cells; risking adverse reactions and increased re-bleeding. An education programme aimed at junior doctors was successful in significantly increasing adherence to national guidelines on transfusion and improving patient care. Simple educational methods are therefore effective at improving care by promoting evidence-based practice. Future auditing would aid in assessing the sustainability of this improvement.