Precision Diagnostics and Therapeutics Program, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
Department of Laboratory Medicine and Pathobiology, University of Toronto Temerty Faculty of Medicine, Toronto, Ontario, Canada.
BMJ Open Qual. 2024 Apr 3;13(2):e002660. doi: 10.1136/bmjoq-2023-002660.
Up to 50% of blood is transfused inappropriately despite best evidence. In 2020, Choosing Wisely Canada launched a major national programme, 'Using Blood Wisely', the aim was to engage hospitals to audit their red blood cell transfusion use against national benchmarks and participate in a programme to decrease inappropriate use.
Using Blood Wisely is a quality improvement programme including national benchmarks, an audit tool, recommended evidence-based effective interventions and a designation to reward success. Hospital engagement was measured using the number of hospitals signing up, performing a baseline audit, submitting the planning survey, entering two or more audits and achieving hospital designation. Barriers to implementation were collected.
From 1 September 2020 to 31 December 2022, 229 individual hospitals signed up over time to participate. Their results are reported as 159 hospitals and hospital groups. Collectively, this accounts for 72% of the blood used in Canada. Overall, 147 (92%) performed a baseline audit, 10 (6%) submitted a planning survey and 130 (82%) entered two or more audits. At baseline (time of enrolment), 75 (51%) met both benchmarks. The designation was awarded to 62 (39%) hospital groups (a total of 105 individual hospitals) that met and sustained benchmarks. Barriers to implementation included human resource shortages, lack of local expertise to advise the team, need for more education of transfusion prescribers and competing priorities.
In its initial phase, Using Blood Wisely engaged a substantial number of hospitals in transfusion quality improvement work and maintained that engagement. This large-scale engagement across a big country was more successful than anticipated. Additional efforts are needed to rigorously evaluate the programme's impact on utilisation.
尽管有最佳证据，但仍有多达 50%的血液输注不当。2020 年，加拿大明智选择组织发起了一项重大的全国性计划“明智用血”，旨在让医院对其红细胞输注使用情况进行审计，使其与国家基准进行对比，并参与一项减少不当使用的计划。
“明智用血”是一个质量改进计划，包括国家基准、审计工具、推荐的基于证据的有效干预措施以及一项表彰成功的指定。医院参与度通过签署协议、进行基线审计、提交规划调查、进行两次以上审计和实现医院指定的医院数量来衡量。收集实施障碍。
从 2020 年 9 月 1 日至 2022 年 12 月 31 日，有 229 家医院陆续签约参与。他们的结果以 159 家医院和医院团体报告。总的来说，这占加拿大使用血液的 72%。总体而言，147 家（92%）进行了基线审计，10 家（6%）提交了规划调查，130 家（82%）进行了两次或以上的审计。在基线（注册时），75 家（51%）符合两个基准。有 62 个（39%）医院团体（共 105 家）符合并维持基准而获得指定。实施障碍包括人力资源短缺、缺乏为团队提供建议的本地专业知识、需要对输血开处方者进行更多教育以及存在竞争优先级。
在初始阶段，“明智用血”使大量医院参与了输血质量改进工作，并保持了这种参与度。在这个大国的大规模参与比预期的更为成功。需要进一步努力严格评估该计划对使用率的影响。
