• Jacob T Gutsche, Prakash A Patel, Rebecca M Speck, Pavan Atluri, and Zev Noah Kornfield.
• School of Medicine, Department of Anesthesiology and Critical Care, The University of Pennsylvania, Philadelphia, PA. Electronic address: jacob.gutsche@uphs.upenn.edu.
• J. Cardiothorac. Vasc. Anesth.. 2013 Dec 1;27(6):1189-93.

BackgroundAnemia is a common clinical problem in cardiac surgery patients in the postoperative period and may result in transfusion in up to 90% of this population. There is tremendous variation in transfusion rates by hospital and individual physician. It is unknown if implementation of a clinical practice guideline lowers unnecessary transfusion in hospital practices that already have a restrictive transfusion culture .ObjectiveTo evaluate transfusion practice before and after implementation of a clinical practice guideline.DesignPre/post intervention study.SettingSixteen bed surgical intensive care unit in an academic hospital.ParticipantsFour hundred ninety-five adult patients undergoing cardiac surgery.InterventionsImplementation of an anemia clinical practice guideline reinforced with education and retrospective audit/feedback.Measurements And Main ResultsA total of 252 pre-intervention and 243 postintervention cases were examined. Unnecessary transfusion occurred in 14.7% of pre-intervention patients and decreased to a rate of 8.1% after guideline implementation (p = 0.016).ConclusionsThis study suggests that clinical guideline implementation utilizing guideline development, education, and compliance audit/feedback may reduce unnecessary transfusion in cardiac surgery patients. A fully powered prospective trial would be necessary to validate these findings.© 2013 Elsevier Inc. All rights reserved.

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