Reduction of red blood cell transfusions by implementation of a concise pretransfusion checklist

Background: This study assesses the effect of the implementation of a concise pretransfusion checklist as a means for restrictive blood transfusion strategy. Objectives: To achieve an optimal use of red blood cells and to prevent overdosing of transfusion by implementation of a decision support algorithm. Methods: To ensure adequate use of red blood cells, physicians were obliged to complete the checklist with pretransfusion patient information before transfusion was approved. Laboratory employees checked the information and provided approval or refused to process the request. The red blood cell transfusion events, length of stay and mortality were analysed during a pre-and post-implementation period of 1 year. Results: Transfusion requests decreased by 17.0%. The proportion of 1-unit and 2-unit transfusions decreased by 5.6% and 29.2%, respectively, corresponding with a total red blood cell units reduction of 22.6% and a yearly direct local cost reduction of 190.000(sic). The median length of stay of transfused patients on wards decreased by 1.07 days (P < 0.05). Average pre-and post-transfusion haemoglobin levels before and after implementation of the checklist decreased by 0.32-0.35 g L-1 (P < 0.05) for one unit red blood cell transfusions and 0.72-0.87 g L-1 (P < 0.05) for two units of red blood cell transfusions. Conclusion: Decision support for transfusion necessity, in the form of a concise checklist as part of the transfusion request, is an example of a successful restricted blood transfusion strategy. The checklist can be applied in other hospitals as well.