Clinician-driven model creates opportunity for perioperative patient education AIDS

Abstract

Introduction Despite readily available guidelines and convincing evidence for limiting transfusions, unjustified variability in perioperative red blood cell (RBC) transfusion practice remains in cardiac surgical patients. We hypothesize that sharing the decision of when to transfuse RBC with cardiac surgical patients will limit unjustified perioperative transfusion. Herein, we present the results of a survey to better delineate the knowledge of and preference for perioperative RBC transfusion by clinician and patients. Methods The final provider participant survey contained 11 questions plus 10 demographic questions, while the final patient participant survey contained 10 questions plus 9 demographic questions. Survey content and research method was approved by the local Institutional Review Board. Clinician surveys were distributed to the Departments of Cardiology, Cardiac Surgery, Internal Medicine and Anesthesiology using Research Electronic Data Capture (REDCap). Patient surveys were distributed to consecutive patients presenting to our Preoperative Clinic for one week. Patient responses were manually entered into excel. Participant responses were summarized and compared using JMP Pro 14. Results Of the 313 surveys distributed to clinicians, and 121 to patients, 99 (32%) and 93 (77%) were returned, respectively. Of the 6 questions that tested knowledge, three differed significantly between clinicians and patients (Table): on a seven-category Likert scale, clinicians felt more knowledgeable than patients about the hemoglobin level at which red blood cells should be transfused (5.5 vs 2.1; p Discussion In a reasonably well-represented sample of participants from a large, academic tertiary care hospital, we highlight significant differences in the basic knowledge about and preferences for perioperative red blood transfusion between clinicians and patients. Our results strongly imply a clinician-driven decision model to transfuse RBCs, and supports future efforts to develop decision aids to facilitate patient involvement in the shared decision-making of when and how much to transfuse.