Transfusing Wisely - Implementing a Transfusion Quality Improvement Project: An SHM Choosing Wisely Quality Improvement Implementation Module-References

References

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This collection of references centers on the clinical practices, risks, and management strategies related to red blood cell (RBC) transfusions. Several systematic reviews and meta-analyses (e.g., Rohde et al., 2014; Hill et al., 2003; Kim et al., 2017) highlight the association between RBC transfusions and increased risks of healthcare-associated infections and surgical site infections, emphasizing the need for cautious transfusion practices. Cost analyses (Blumber et al., 1996) and studies on immunologic changes after transfusion (Innerhofer et al., 1999) provide insight into both economic and physiological impacts of transfusions. Clinical trials and comparative studies (Hebert et al., 1999; Villanueva et al., 2013; Holst et al., 2014; Carson et al., 2011; Mazer et al., 2018) explore restrictive versus liberal transfusion thresholds across various patient populations, including critical care, gastrointestinal bleeding, septic shock, hip surgery, cardiac surgery, and traumatic brain injury, generally supporting more restrictive strategies to improve outcomes. Multiple references address the role of clinical decision support systems and transfusion protocols in optimizing blood usage and reducing unnecessary transfusions (Jenkins et al., 2017; Goodnough et al., 2014; Carson et al., 2016). Guidelines and quality improvement resources such as Choosing Wisely recommendations (reference 19) and implementation toolkits for anemia management (Jenkins et al.) underscore the movement toward evidence-based, patient-centered transfusion practices. Collectively, this bibliography underscores the clinical complexity of blood transfusion, advocating for judicious use guided by rigorous evidence to balance benefits against risks such as infection and immunomodulation, while also addressing costs and improving patient outcomes through decision support and standardized protocols.

Keywords

red blood cell transfusion

healthcare-associated infections

surgical site infections

restrictive transfusion thresholds

liberal transfusion strategies

clinical decision support systems

transfusion protocols

anemia management

evidence-based transfusion practices

transfusion-related immunomodulation