In the past 20 years, the “10/30” rule for blood transfusions has been replaced with conservative guidelines which have demonstrated improved patient outcomes and reduced overall healthcare costs. Hospitals across the country have enlisted transfusion subcommittees to review the appropriateness of blood transfusions. Within medical training, resident physicians rotate with different attendings who have variable practices of transfusion thresholds. In fact, studies have shown that internal medicine residents have poor transfusion medicine knowledge and there are opportunities for focused training. Thus, after multiple resident cases demonstrated inappropriate use of blood transfusions, it was clear that a resident initiated QI project was needed to update residents on the latest transfusion guidelines.
To educate medicine resident physicians on the newest blood transfusion guidelines through short lecture series and case reviews. A pre-test and post-test will assist in determining impact of this intervention.
A pre-test (Figure 1) was created based on the newest recommendations from the October 2016 JAMA reported American Association of Blood Banks Guidelines. The lecture series began with the pre-test, in which resident physicians identified their training level. These residents then attended a lecture series composed of description of the institution’s transfusion subcommittee, presentation of the newest transfusion guidelines and the data supporting them, as well as a discussion of three cases that had been reviewed by the institution’s transfusion subcommittee as “inappropriate” transfusions. Following the lecture, the same pre-test was administered as a post-test, and average scores across each level of training were calculated and compared using simple student T-score tests (Figure 2). Mean pre-test score across all trainee levels was 52.5% and increased to 76.7% post-lecture, with p<0.042 when assuming the null hypothesis.
Following the lecture series, medicine residents demonstrated an improved comprehension of the newest conservative transfusion guidelines based on pre-test and post- test scores. A resident initiated QI project with lecture series and case discussion from one’s own institution is an effective intervention in educating residents about the newest practice guidelines. Future planned interventions include providing the lecture series to surgical residents as well as attendings to further implement the safest and most cost effective blood transfusion practices.