Durability of response to a targeted intervention to modify clinician transfusion practices in a major teaching hospital

Objectives: To determine the durability of a successful intervention to modify clinician transfusion practices, and to compare current transfusion practices in the "intervention" hospital with those in a hospital with no intervention. Design: Prospective, descriptive study. Setting: Two major metropolitan teaching hospitals - Royal Melbourne Hospital and Western Hospital, Footscray. Subjects: Consecutive patient transfusion episodes for red cells, platelets and fresh frozen plasma (FFP). Outcome measures: Appropriateness of transfusion according to intervention guidelines; comparison of inappropriate transfusion rates before the intervention, immediately after the intervention and 3 years after the intervention. Comparison of inappropriate transfusion rates in intervention and non-intervention hospitals. Results: Inappropriate transfusion rates 3 years after the intervention were 20% for red cells, 27% for platelets, and 43% for FFP. These were significantly higher than equivalent rates reported immediately after the intervention. Inappropriate transfusion rates at the non-intervention hospital were comparable (26% for red cells, 36% for platelets and 52% for FFP). Conclusion: Appropriate clinician transfusion practices have proven difficult to sustain 3 years after hospital guideline generation and promotion. A "gate-keeping" role by hospital blood bank staff proved impractical in the long term.