56 Chapter 2 Historical RBC trends Trend/Theme Drivers/Factors Definition Example quote Decreased demand of RBCs Evidence: public This sub-code describes how ‘public’ evidence contributed towards the lowering of RBC demand . You have, for red blood cells, the Jehovah’s Witnesses showing that you can go very low before you really need an urgent transfusion. Less logistic problems due to availability of drugs This sub-code describes how changes in the supply chain/logistics allowed more drugs to be readily available and contributed towards decreased need for RBC transfusions. So I will transfuse less of red blood cells because I have less logistic problems by using real drugs on the shelf. Clinical chemist and transfusion committee This sub-code describes the distinct role and position of the clinical chemist (CC) in the Netherlands, and encompasses the historical journey of the CC’s rise into recognized importance in the hospitals (from being a supplier to a consultant), the training they had/have to undergo, their daily tasks in the hospitals, the ways they build connection, communication, and implementation of the Dutch national guidelines in the hospitals, and their participation or leadership in the transfusion committees in order to reduce blood use in the Netherlands. The clinical chemists in the Netherlands, they are very aware, very aware, of this single unit transfusion policy. I think when a clinician asks for 2 units, sometimes they [clinical chemists] call them and say, “Why do you need 2? Can you not just give 1?” So they [clinical chemists] monitor and give feedback. There are also very active committees in the hospitals, usually, who collect data from the wards and then they give feedback to the doctors about their blood use. Focus on using algorithms This sub-code describes how improved algorithms was perceived to be the driver for the reduction of RBC demand. It’s not based on scientific evidence, this evolution, this trend. It’s based on simply, well, communication between people saying that algorithm, and guidelines, and guidance are very important to lessen the heterogenating practice. This is very important.
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