Utilization of blood products has been studied among anesthesiologists, surgeons, and intensivists, but little is known about blood utilization among hospitalists. The purpose of this study was to examine the transfusion thresholds and factors that affect blood utilization among hospitalist physicians.
A questionnaire with 8 case scenarios was given to a hospitalist group at a community teaching hospital. The questionnaire was designed to determine the transfusion triggers for various conditions and if the transfusion threshold changed when various factors were introduced. The responses were compared to determine differences in the transfusion practices between practitioners and a paired t test was used to analyze which factors altered the transfusion threshold.
Of the 20 members of the group, 15 responded to the questionnaire. In 7 of the 8 patient scenarios, the range of hemoglobin suggested for transfusion was ≥2 g/dL. In 5 of the 8 patient scenarios, the range of hemoglobin suggested for transfusion was S3 g/dL. Statistical analysis demonstrated a standard deviation of more than 1 g/dL of hemoglobin occurred in patients with septic shock, subacute gastrointestinal bleeding, hemodilution, anemia of chronic disease, cellulitis, decreased functional status, and mild and severe heart disease. Statistically significant factors that raised the transfusion threshold among surveyed physicians were advanced age (P = .0003), poor functional status (P = .0009), sickle cell crisis with no history of blood transfusion (P = .0416), and severe coronary disease (P = .0119).
The data suggest that blood utilization varies widely between hospitalists in a broad range of disease states. The variation may be attributed to lack of knowledge of current transfusion guidelines. Advanced age, poor functional status, transfusion‐naive sickle cell status, and increased severity of coronary disease raised the transfusion threshold. The study findings appear to reflect the overall lack of evidence either for or against blood transfusion in nonsurgical, non‐intensive care unit patients. Future studies are needed to determine if these practice patterns are representative among hospitalists and in what situations blood transfusion improves or adversely affects patient outcomes.
D. VanderEnde, none.
To cite this abstract:VanderEnde D, O'Malley E. A Survey of Hospitalists Transfusion Practices. Abstract published at Hospital Medicine 2008, April 3-5, San Diego, Calif. Abstract 79. Journal of Hospital Medicine. 2008; 3 (suppl 1). https://www.shmabstracts.com/abstract/a-survey-of-hospitalists-transfusion-practices/. Accessed July 17, 2019.