Accumulating evidence supports restrictive RBC transfusion practices, and guidelines such as those recently released by the AABB recommend transfusing when hemoglobin levels fall below 7-8 g/dL for most patients. Adapting new clinical practices, however, is influenced by many factors, and numerous studies have examined the impact of behavior modifications, such as education, clinical protocols, institutional guidelines and policies, and other techniques. In order to summarize the current literature, researchers identified 84 studies (3 randomized clinical trials and 81 non-randomized studies) for a systematic review and meta-analysis. Based on meta-analysis of 33 non-randomized studies, behavior modifications for transfusion providers decreased the odds of patients receiving RBC transfusions (pooled OR, 0.70; 95% CI, 0.65 to 0.76) and inappropriate transfusions (pooled OR, 0.46; 95% CI, 0.36 to 0.59) compared to patients receiving historical standard of care. There was no statistically significant difference between groups for in-hospital mortality. Since most of the studies evaluated were of low to moderate quality and were at a high risk of bias, it is unclear which behavior modifications are most effective at modifying RBC transfusion practices. Future research should focus on “what works best” and “at what cost”.
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