“Certainly in my institution, we utilize a trigger of 7 [g/dL] and some of us might even push that down to 6 [g/dL],” she said.
Some of the landmark studies including FOCUS and TRACS used a trigger of 8 g/dL and the investigators wanted to give the clinicians a bit of a benefit of doubt, Dr. Yeh responded.
Results of the intervention were met with surprise, but were quickly reinforced with the publication of the TBI and Villanueva studies and an accompanying editorial (N. Engl. J. Med. 2014;371:1459-61) arguing that a transfusion threshold of 7 g/dL is the new normal, he noted.
“We’ve continued on daily rounds to really focus on that [trigger]. We’ve become empowered as the ICU team to say ‘No,’ to argue and at least put up roadblocks when the primary teams are requesting transfusions and ask them to justify why patients need the additional oxygen carrying capacity when they’re waiting on the floor for 3 days and doing totally fine,” Dr. Yeh said.
As for how they deal with offending providers or outliers, electronic records identify who signed each transfusion order, even if it’s in the dead of night, and simply showing physicians where they stack up with their peers can be the biggest driver of practice change. The team no longer performs monthly audits due to time constraints, but hopes to resume e-mail interventions once MGH’s transition to a new electronic medical system is complete, Dr. Yeh said in an interview.