How do we improve massive transfusion protocol adherence among anesthesia providers?

BACKGROUND: Previous studies have called for the implementation of provider reeducation efforts to improve massive transfusion protocol adherence. OBJECTIVE: This quality improvement project implemented an educational module designed to increase anesthesia provider adherence to the hospital's massive transfusion protocol during the intraoperative massive transfusion of trauma patients. It also aimed to increase survival rates for trauma patients in the operating room for whom a massive transfusion protocol had been activated. METHODS: An educational intervention was developed and disseminated to anesthesia providers. The intervention consisted of a PowerPoint presentation, an expert question-and-answer session, and the distribution of a badge card. Provider knowledge of and confidence in utilizing the protocol was evaluated before and after the intervention, while provider adherence to the packed red blood cell:fresh frozen plasma and packed red blood cell:platelet ratios outlined in the massive transfusion protocol and patient survival were assessed for 4 months pre- and post-implementation of the intervention. RESULTS: The knowledge test scores of the 18 anesthesia providers participating in the education significantly improved after the intervention (p = .0005). Provider confidence in utilizing the massive transfusion protocol also substantially improved. Provider adherence to the massive transfusion protocol was determined for 20 trauma cases (11 pre-and 9 post-intervention). Although the adherence to the packed red blood cell:fresh frozen plasma ratio and packed red blood cell:platelet ratios improved, patient survival rates did not increase. CONCLUSION: Project findings suggest that provider massive transfusion protocol reeducation efforts improve provider protocol knowledge, confidence, and adherence.

Duke Scholars

Author Nicole Renee Guinn Anesthesiology, Neuroanesthesia

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