Vox Sanguinis (2017) ORIGINAL PAPER © 2017 International Society of Blood Transfusion DOI: 10.1111/vox.12493 Educational interventions encouraging appropriate use of blood transfusions A. Abelow, 1 A. Gafter-Gvili, 1,2,3 B. Tadmor, 4 M. Lahav 2,3 & D. Shepshelovich 1,3 1 Medicine A, Rabin Medical Center, Beilinson Hospital, Petach Tikva, Israel 2 Institute of Hematology, Davidoff Center, Rabin Medical Center, Beilinson Hospital, Petach Tikva, Israel 3 Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel 4 Rabin Medical Center, Beilinson hospital, Petach Tikva, Israel Received: 25 August 2016, revised 17 November 2016, accepted 29 December 2016 Background and Objectives The integration of a restrictive packed red blood cells (PRBC) transfusion strategy into daily clinical practice presents a challenge. This study describes the effect of an intervention including educational presentations and computerized alerts on PRBC utilization at a tertiary hospital. Materials and Methods During December 2014, lectures describing recommended PRBC transfusion indications were presented to all non-intensive care depart- ments. Starting from January 2015, an alert was added to the electronic drug ordering system recommending transfusions at a haemoglobin (Hb) level <7 g/dl or Hb < 8 g/dl in symptomatic patients. The physician was not required to acknowledge the alert. Data regarding measured Hb preceding transfusions were collected. The primary end-point was defined as the percentage of PRBC adminis- tered at Hb ≥ 8 g/dl in 2015 compared with 2014. Secondary end-points were the percentage of PRBC administered to patients with Hb < 7 g/dl and the abso- lute number of PRBC transfused in 2015 compared with 2014. Results Compared to 2014, in 2015, the percentage of PRBC transfused when the Hb ≥ 8 g/dl was reduced by 18Á8% (P < 0Á001) and made up 29% of the total PRBC transfused. The absolute number of PRBC transfused decreased by 7Á7%. The percentage of PRBC transfused when the Hb < 7 g/dl increased by 25Á9% (P < 0Á001). Conclusions Following the described intervention, there was a significant improvement in the appropriateness of PRBC transfusions in our medical centre. These changes occurred despite the lack of interruption of the physician’s work- flow from the computerized alert. This simple strategy might be of use in imple- menting a restrictive PRBC transfusion strategy. Key words: appropriate usage, education, packed cells, restrictive strategy, trans- fusions. Introduction There is a large and growing body of evidence favour- ing a restrictive transfusion strategy of packed red blood cells (PRBC), as opposed to a liberal strategy [1–3]. A restrictive strategy is now a part of major transfusion guidelines. The American Association of Blood Banks (AABB) recommends adhering to a restric- tive transfusion strategy of a haemoglobin (Hb) target of 7–8 g/dL in stable, hospitalized patients, with or without pre-existing cardiovascular disease [4]. The Bri- tish Committee for Standards in Hematology recom- mends a transfusion threshold of a Hb of 7 g/dl with a target of 7–9 g/dL [5]. Recognizing the prevalence of unnecessary transfusions, the American Society of Hematology promoted a restrictive transfusion strategy Correspondence: Daniel Shepshelovich, Medicine A, Beilinson Hospital, Jabotinsky 39, Petach Tikva, Israel E-mail: Shepshelovich@yahoo.com 1