Faculty Bibliography

Background/Case Studies: Most United States medical school curricula devote little attention to teaching transfusion medicine (TXNM). From the early stages of their residencies, however, physicians are expected to be able to obtain informed consent for transfusion, administer transfusions, and recognize and treat transfusion reactions. Although there are many transfusion standards designed to ensure patient safety, they also can lead to a false sense of security. The overall limited knowledge of TXNM by most physicians and the reliance on this false sense of security can adversely impact patient safety. In 2010, comprehensive TXNM education was required of all incoming house staff (HS). In 2014, the blood bank staff was able to see the HS's performance question-by-question, and the staff sought to evaluate the impact of the compulsory online education and determine which topics merit additional instruction. Study Design/Methods: An online Transfusion Guidelines tutorial and competency exam, consisting of 25 true/ false questions, was administered. All HS were required to take and pass (score > 80%) the exam. The instruction course and competency exam were accessible to all HS and members of the medical school community on the institution's advanced learning exchange. The competency exams were instantly scored, and the results were reported to the test taker. Results/ Findings: Prior to starting work on July 1, 2014, all incoming HS had taken and scored >80% on the exam. From May1, 2014 to July 1,2014, a total of 977 individuals, including the incoming HS, had completed the tutorial and taken the exam. The average score on the exam was 83.2% (20.8/25). Three questions were answered correctly by <40% of the test-takers. Two questions were answered correctly by 60-69%, 4 questions were answered correctly by 70-79%, 7 questions were answered correctly by 80-89%, and 9 questions were answered correctly by 90-100%. Questions regarding effectiveness of plasma transfusion in correcting PT (39.6%), ABO type of emergency-released RBCs (13.1%), and TA-GVHD prevention (34.6%) were answered incorrectly the most frequently (see Table). Conclusion: Formalized transfusion education for all HS must continue to be conducted. Additional instruction must be developed and deployed to improve the knowledge deficits identified by the exam. (Table Presented)

BACKGROUND: The objective of this study was to characterize variations in packed red blood cell (PRBC) transfusion practices in critically ill patients and to identify which factors influence such practices. We hypothesized that significant variation in transfusion triggers exists among acute care surgeons. METHODS: A survey of PRBC transfusion practices was administered to the American Association for the Surgery of Trauma members. The scenarios examined hemoglobin thresholds for which participants would transfuse PRBCs. RESULTS: A hemoglobin threshold of less than or equal to 7 g/dL was adopted by 45% of respondents in gastrointestinal bleeding, 75% in penetrating trauma, 66% in sepsis, and 62% in blunt trauma. Acute care surgeons modified their transfusion trigger significantly in the majority of the modifications of these scenarios, often inappropriately so. CONCLUSIONS: This study documents continued evidence-practice gaps and wide variations in the PRBC transfusion practices of acute care surgeons. Numerous clinical factors altered such patterns despite a lack of supporting evidence (for or against).