Lee Todd C, Murray Jennifer, McDonald Emily G
Clinical Practice Assessment Unit (Lee, Murray, McDonald) and Division of General Internal Medicine (Lee, McDonald), Department of Medicine, McGill University Health Centre, Montréal, Que.
CMAJ Open. 2019 Jul 25;7(3):E492-E496. doi: 10.9778/cmajo.20180211. Print 2019 Jul-Sep.
Several professional societies have made value-based statements in support of restrictive transfusion strategies. The aim of this study was to determine whether completion of an accredited online training program in transfusion safety could improve transfusion knowledge among medical residents and increase transfusion appropriateness.
We performed a controlled before-after evaluation of a mandatory accredited self-directed training program (Bloody Easy Lite for Physicians) that provides education about transfusion medicine on a 47-bed medical clinical teaching unit at a university-affiliated hospital centre in Montréal. The program consists of 2 modules and takes about 30 minutes to complete. We used the 45-bed medical teaching unit at another Montréal hospital as a contemporary control. We compared resident physicians' pre- and posttest scores and evaluated the impact on transfusion appropriateness by comparing the proportion occurring below a hemoglobin concentration of 80 g/L before (April 2013-June 2015) and after (July 2015-January 2016) the intervention.
Of the 55 residents on the intervention unit, 53 (96%) completed the training. The median pretest score was 50% (inter-quartile range [IQR] 40%-60%). The median posttest score was 90% (IQR 80%-90%) for module 1 and 80% (IQR 80%-90%) for module 2 ( < 0.001 for both pre-post comparisons). The proportion of transfusions below 80 g/L increased from 80.1% to 86.9% ( = 0.04) on the intervention unit and remained relatively unchanged on the control unit (75.6% v. 71.1%, = 0.4). Although there was no statistically significant difference between the units in the proportion of transfusions below 80 g/L before the intervention ( = 0.07), a significant difference was observed after the intervention ( = 0.002).
Mandatory training in transfusion safety via an online program resulted in improved transfusion knowledge among residents and an increase in the proportion of transfusions occurring at a hemoglobin concentration below 80 g/L. This low-cost educational initiative may improve transfusion appropriateness.
多个专业协会已发表基于价值的声明，支持限制性输血策略。本研究的目的是确定完成经认可的输血安全在线培训项目是否能提高住院医师的输血知识，并增加输血的合理性。
我们对一个强制性的经认可的自主培训项目（针对医生的简易输血课程）进行了前后对照评估，该项目在蒙特利尔一家大学附属医院中心的一个拥有47张床位的内科临床教学单元提供输血医学教育。该项目由2个模块组成，大约需要30分钟完成。我们将蒙特利尔另一家医院的拥有45张床位的内科教学单元作为同期对照。我们比较了住院医师的测试前和测试后分数，并通过比较干预前（2013年4月至2015年6月）和干预后（2015年7月至2016年1月）血红蛋白浓度低于80g/L时输血比例的变化，评估了对输血合理性的影响。
干预单元的55名住院医师中，53名（96%）完成了培训。测试前分数中位数为50%（四分位间距[IQR]40%-60%）。模块1测试后分数中位数为90%（IQR 80%-90%），模块2为80%（IQR 80%-90%）（前后比较均P<0.001）。干预单元血红蛋白浓度低于80g/L时的输血比例从80.1%增至86.9%（P=0.04），而对照单元相对保持不变（75.6%对71.1%，P=0.4）。尽管干预前各单元血红蛋白浓度低于80g/L时的输血比例差异无统计学意义（P=0.07），但干预后差异有统计学意义（P=0.002）。
通过在线项目进行输血安全强制性培训可提高住院医师的输血知识，并增加血红蛋白浓度低于80g/L时输血的比例。这项低成本的教育举措可能会提高输血的合理性。
