Investigating Obstetric Blood Transfusion Practice in New South Wales (NSW)

Abstract

Aims to investigate obstetric blood transfusion practice at maternity hospitals in NSW with a range of geographical locations, clinical settings and obstetric transfusion rates including the antepartum use of intravenous (IV) iron and postpartum use of single unit red blood cell (RBC) transfusions. Methods A qualitative research study using semi-structured interviews was conducted. Nine maternity hospitals were chosen to cover a range of clinical settings and obstetric transfusion rates in NSW. Interviews were conducted in person with haematologists, obstetricians and midwives. Results There were 5 high-transfusing and 4 low-transfusing hospitals. 125 interviews were conducted, 61 with doctors: 42 with obstetric training and 19 with haematology training. High-transfusing hospitals were more likely to be rural or geographically isolated, have fewer staff numbers, smaller blood inventories and less stringent blood product regulation. Hospital/pharmaceutical, clinician and patient factors influenced the decision to use IV iron. Clinician-based and external factors influenced single unit transfusion use. Most doctors with obstetric training (54%) would initiate transfusion with two RBC units. Conclusion Hospital, clinician and patient-level factors influenced obstetric transfusion practice. Clinical context, resource availability, clinician knowledge and experience, and perceptions of utility of specific interventions were important. The findings have implications for clinician education, blood product provision and inventory management.