Reducing low-value care in surgery: assessment of a campaign targeting unnecessary blood transfusions
Linnéa Syrén, Martin AlmqvistAbstract
Introduction
Erythrocyte transfusion is a common intervention in Swedish health care. Given its frequency, risks, and clear guidelines, transfusion practice is a relevant target for de-implementation of low-value care. In 2024, a low-intensity Choosing Wisely-inspired de-implementation campaign was introduced at the Department of Surgery, Skåne University Hospital. We evaluated the campaign’s impact on erythrocyte transfusion practice and explored staff perceptions of local transfusion routines and the campaign.
Methods
A mixed-methods design was used. Quantitative analyses included department-level transfusion data from 2023 (pre-campaign) and 2025 (post-campaign) and a retrospective chart review of 328 transfusion episodes across both periods. The qualitative component consisted of semi-structured interviews with clinical staff and an online physician survey.
Results
Transfusion intensity decreased from 6.28 to 5.72 units per 100 inpatient days (-8.9%). Hemoglobin (Hb)-based adherence increased from 7.5% to 17.5% and pre-transfusion Hb-levels were lower post-campaign. Survey responses (n = 42) indicated that the majority were aware of the campaign, reported increased reflection, and that more than a third perceived themselves as more restrictive than before. Interviews (n = 14) suggested that many physicians already viewed their practice as restrictive, describing a gradual shift over time rather than a change attributable to the campaign. Nurses reported mixed experiences, with some perceiving increased restrictiveness and others little difference.
Discussion
A low-intensity campaign was associated with improvements in transfusion practice and increased reflection, but limited perceived behavioural change.