Results of meta-analysis for RBC usage and patient outcomes
| Outcome measures | Multimodal | Education | Protocol/algorithm | Guidelines | CPOE and decision support | Reminders | Audit and feedback | Audit approval | Policy | Pooled estimate* (95% CI) | I2 (%); Q-statistic (P values) |
| Odds of patients being transfused (OR, 95% CI) | 0.73 (0.67 to 0.79) | 0.74 (0.44 to 1.24) | 0.34 (0.19 to 0.60) | 0.17 (0.01 to 3.15) | 0.82† (0.69 to 0.97) | 1.51† (0.86 to 2.66) | – | 0.73† (0.70 to 0.78) | 0.71† (0.53 to 0.95) | 0.70 (0.65 to 0.76) | 90.5%; p=0.0001 |
| Odds of patients being inappropriately transfused (OR, 95% CI) | 0.54 (0.41 to 0.71) | – | 0.25† (0.16 to 0.39) | 0.07† (0.02 to 0.19) | – | 0.13† (0.05 to 0.30) | 1.74† (1.39 to 2.19) | 0.16† (0.07 to 0.40) | – | 0.46 (0.36 to 0.59) | 97.6%; p=0.0001 |
| Difference in RBC units transfused (WMD, 95% CI) | −0.34 (−0.37 to −0.31) | – | −0.13† (−0.35 to 0.09) | −1.42† (−1.67 to −1.17) | −0.20† (−0.35 to −0.05) | – | – | – | – | −0.35 (−0.38 to −0.32) | 99.9%; p=0.0001 |
| Odds of patient in-hospital mortality (OR, 95% CI) | 0.91 (0.81 to 1.03) | 0.88 (0.67 to 1.14) | 0.35 (0.06 to 2.20) | – | 1.33† (1.02 to 1.73) | 1.15† (0.51 to 2.62) | – | 0.81† (0.73 to 0.90) | – | 0.92 (0.84 to 1.02) | 64.8%; p=0.001 |
| Difference in hospital LOS (WMD, 95% CI) | −0.42 (−0.79 to −0.06) | – | −6.30† (−14.43 to 1.83 | −3.00† (−5.74 to −0.26) | −1.66† (−2.80 to −0.52) | – | – | – | – | −0.63 (−1.02 to −0.24) | 79.7%; p=0.0001 |
| Difference in pretransfusion Hgb level (WMD, 95% CI) | −0.28 (−0.48 to −0.08) | – | – | – | – | – | – | – | – | −0.28 (−0.48 to −0.08) | 95.5%; p=0.0001 |
*Pooled estimate from both single intervention and multimodal intervention studies.
†Point estimate derived from a single study.
CPOE, computerised physician order entry; Hgb, haemoglobin; LOS, length of stay; RBC, red blood cell; WMD, weighted mean difference.