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Objectives To assess transfusion practices at a Canadian tertiary care center before and after a hospital‐wide blood management educational campaign based on the Choosing Wisely toolkit. Background Red blood cell (RBC) transfusions are an essential intervention in obstetrics and gynaec ology (O&G). However, with limited guidelines outlining the appropriate use of RBC transfusions, clinicians routinely transfuse based on haemoglobin values and habits. Methods/Materials We conducted a retrospective chart review of all patients who received a RBC transfusion while admitted under an O&G provider in two 12‐month periods—before and after the intervention. The campaign consisted of Grand Rounds, formal and informal teaching, and posters placed within the hospital. We judged appropriateness from a set of criteria guided by the status of ongoing bleeding, pre‐transfusion haemoglobin, and the number of units ordered simultaneously. Results Transfusion appropriateness was poor in pre‐ and post‐intervention periods (46% vs. 51%, p = 0.59). The overall rate of RBC transfusion was reduced from 1.8% to 1.2% (83/4610 vs. 55/4618, p = 0.02) after the intervention. There was a 52% reduction in the total number of RBC units of transfused (229 vs. 111, p < 0.001), a 33% reduction in the number of patients transfused (83 vs. 55, p = 0.016), and fewer multiple‐unit transfusions without reassessment (39 vs. 13, p = 0.005). Conclusion RBC transfusion appropriateness remained low after a hospital‐wide educational campaign. However, there was a marked decrease in overall transfusion use, reflecting the adoption of more restrictive transfusion practices. The low rate of transfusion appropriateness represents an opportunity for further improvement.

INTRODUCTION: Red blood cell (RBC) transfusions are a potentially life-saving intervention in Obstetrics and Gynecology (O&G). With limited guidelines outlining appropriate use of RBC transfusions, clinicians often transfuse based solely on low hemoglobin values and habit. Our aim was to assess transfusion practices at a Canadian tertiary care center before and after a hospital-wide blood management educational campaign based on the Choosing Wisely toolkit. METHODS: Following approval from our Institutional Review Board, we conducted a retrospective chart review of all patients who received a RBC transfusion while admitted under an O&G provider in two 12-month periods, before and after the intervention. The campaign consisted of Grand Rounds presentations, formal and informal teaching, and posters placed around the hospital. Appropriateness was determined from a set of criteria composed of the presence or absence of active bleeding, initial hemoglobin, and number of units ordered at a time. RESULTS: Before and after transfusion rates were 1.8% and 1.2% respectively (83/4,610 vs 55/4,618 P=.016). There was a 52% reduction in total number of RBC units transfused (229 vs 111 P<.001), a 33% reduction in number of patients transfused (83 vs 55 P=.016), and fewer multiple unit transfusions without reassessment (39 vs 13 P=.005). The rate of transfusion appropriateness was low in both the pre and post intervention periods (46.5% vs 50.7% P=.59). CONCLUSION: Following a hospital-wide education campaign, there was a marked decrease in overall use of transfusion reflecting adoption of a more restrictive transfusion practice. The low rate of transfusion appropriateness represents an opportunity for further improvement.

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