The <scp>AABB</scp> recommendations for the <i><scp>C</scp>hoosing <scp>W</scp>isely</i> campaign of the <scp>A</scp>merican <scp>B</scp>oard of <scp>I</scp>nternal <scp>M</scp>edicine

Callum, Jeannie; Waters, Jonathan H.; Shaz, Beth H.; Sloan, Steven R.; Murphy, Michael

doi:10.1111/trf.12802

Cited by 154 publications

(127 citation statements)

References 71 publications

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“…Although generally low, the risk of adverse events from transfusion, including alloimmunization, transfusion reactions, and infection are higher than the risks of adverse events from oral or intravenous iron replacement [36,37]. Transfusion is also more costly than iron replacement, particularly oral iron replacement which can cost as little as five cents a day [33,38]. Thus in most cases it is both safer and more cost-effective to correct iron deficiency, rather than to transfuse red blood cells.…”

Section: Discussionmentioning

confidence: 99%

Identifying existing Choosing Wisely recommendations of high relevance and importance to hematology

et al. 2016

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Choosing Wisely (CW) is a medical stewardship initiative led by the American Board of Internal Medicine Foundation in collaboration with professional medical societies in the United States. In an effort to learn from and leverage the work of others, the American Society of Hematology CW Task Force developed a method to identify and prioritize CW recommendations from other medical societies of high relevance and importance to patients with blood disorders and their physicians. All 380 CW recommendations were reviewed and assessed for relevance and importance. Relevance was assessed using the MORE TM relevance scale. Importance was assessed with regard to six guiding principles: harm avoidance, evidence, aggregate cost, relevance, frequency and impact. Harm avoidance was considered the most important principle. Ten highly relevant and important recommendations were identified from a variety of professional societies. Recommendations focused on decreasing unnecessary imaging, blood work, treatments and transfusions, as well as on increasing collaboration across disciplines and considering value when recommending treatments. Many CW recommendations have relevance beyond the society of origin. The methods developed by the ASH CW Task Force could be easily adapted by other Societies to identify additional CW recommendations of relevance and importance to their fields.

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Section: Discussionmentioning

confidence: 99%

Identifying existing Choosing Wisely recommendations of high relevance and importance to hematology

et al. 2016

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“…Recently, both the American Medical Association and the Choosing Wisely Campaign have highlighted RBCT as an overused treatment to be targeted in quality improvement initiatives (15,16). Indeed, transfusion practices vary significantly in both overall rates of RBCT use and triggers for RBCT administration (7,17).…”

Section: Introductionmentioning

confidence: 99%

The impact of perioperative blood transfusions on short-term outcomes following hepatectomy

Hallet¹,

Mahar²,

Nathens³

et al. 2018

Hepatobiliary Surg. Nutr.

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Background: Bleeding and need for red blood cell transfusions (RBCT) remain a significant concern with hepatectomy. RBCT carry risk of transfusion-related immunomodulation that may impact post-operative recovery. This study soughs to assess the association between RBCT and post-hepatectomy morbidity. Two exposure groups were created based on RBCT. Primary outcomes were 30-day major morbidity and mortality. Secondary outcomes included 30-day system-specific morbidity and length of stay (LOS). Relative risks (RR) with 95% confidence interval (95% CI) were computed using regression analyses. Sensitivity analyses were conducted to understand how missing data might have impacted the results.Results: A total of 12,180 patients were identified. Of those, 11,712 met inclusion criteria, 2,951 (25.2%) of whom received RBCT. Major morbidity occurred in 14.9% of patients and was strongly associated with RBCT (25.3% vs. 11.3%; P<0.001). Transfused patients had higher rates of 30-day mortality (5.6% vs. 1.0%; P<0.0001). After adjustment for baseline and clinical characteristics, RBCT was independently associated with increased major morbidity (RR 1.80; 95% CI: 1.61-1.99), mortality (RR 3.62; 95% CI: 2.68-4.89), and 1.29 times greater LOS (RR 1.29; 95% CI: 1.25-1.32). Results were robust to a number of sensitivity analyses for missing data.Conclusions: Perioperative RBCT for hepatectomy was independently associated with worse shortterm outcomes and prolonged LOS. These findings further the rationale to focus on minimizing RBCT for hepatectomy, when they can be avoided.

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“…In the American Board of Internal Medicine's Choosing Wisely campaign, the AABB recommended that single unit RBC transfusions be administered for nonbleeding hospitalized patients [57], echoing recommendations originally published over 20 years ago by the American College of Physicians [58]. Additional RBC units should be prescribed only after reassessment of the patient between transfusion events.…”

Section: Clinical Practice Guidelinesmentioning

confidence: 99%

Is there a “magic” hemoglobin number? Clinical decision support promoting restrictive blood transfusion practices

Goodnough

Shah

2015

American J Hematol

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Blood transfusion has been identified as one of the most frequently performed therapeutic procedures, with a significant percentage of transfusions identified to be inappropriate. Recent key clinical trials in adults have provided Level 1 evidence to support restrictive red blood cell (RBC) transfusion practices. However, some advocates have attempted to identify a “correct” Hb threshold for RBC transfusion; whereas others assert that management of anemia, including transfusion decisions, must take into account clinical patient variables, rather than simply one diagnostic laboratory test. The heterogeneity of guidelines for blood transfusion by a number of medical societies reflects this controversy. Clinical decision support (CDS) uses a Hb threshold number in a smart Best Practices Alert (BPA) upon physician order, to trigger a concurrent utilization self‐review for whether blood transfusion therapy is appropriate. This review summarizes Level 1 evidence in seven key clinical trials in adults that support restrictive transfusion practices, along strategies made possible by CDS that have demonstrated value in improving blood utilization by promoting restrictive transfusion practices. Am. J. Hematol. 90:927–933, 2015. © 2015 Wiley Periodicals, Inc.

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The AABB recommendations for the Choosing Wisely campaign of the American Board of Internal Medicine

Cited by 154 publications

References 71 publications

Identifying existing Choosing Wisely recommendations of high relevance and importance to hematology

Identifying existing Choosing Wisely recommendations of high relevance and importance to hematology

The impact of perioperative blood transfusions on short-term outcomes following hepatectomy

Is there a “magic” hemoglobin number? Clinical decision support promoting restrictive blood transfusion practices

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