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Purpose <p>Massive Hemorrhage Protocols improve outcomes for adults with severe hemorrhage, yet only 65% of Ontario hospitals had implemented one by 2018. In response, a Massive Hemorrhage Protocol toolkit was developed and disseminated province-wide in 2021. This study compares Massive Hemorrhage Protocol adoption and content in Ontario hospitals in 2023 versus 2018 using a pre- and post-toolkit rollout survey.</p> Methods <p>A 98-question survey was emailed to transfusion medicine laboratory directors or their delegate at 159 hospitals in 2023, 2 years after a provincial Massive Hemorrhage Protocol toolkit rollout that included a 1-day virtual symposium. Results were compared with the 2018 survey containing 82 identical core questions using Chi-square test, Fisher exact test, and Wilcoxon rank-sum nonparametric tests for quantitative data, and content analysis for qualitative data. </p> Results <p>The 2023 survey achieved a 100% response rate (<i>n</i> = 159); most respondents (<i>n</i> = 156) were transfusion staff. Hospitals with a Massive Hemorrhage Protocol increased significantly from 65% (<i>n</i> = 150) in 2018 to 77% (<i>n</i> = 159) in 2023 (<i>p</i> = 0.02). Small transfusion hospitals (&lt; 5000 red blood cell units transfused/year) saw an increase in Massive Hemorrhage Protocol adoption from 60 to 74% (<i>p</i> = 0.02). By 2023, 95% (<i>n</i> = 159) of hospitals had/were implementing a Massive Hemorrhage Protocol. However, gaps in alignment to evidence-based recommendations remained, including hypothermia monitoring (missing in 25% of Massive Hemorrhage Protocols) tranexamic acid dosing (missing in 19%), and quality metric tracking (missing in 55%). Pediatric content was absent in 45% of Massive Hemorrhage Protocols in health centers caring for children. </p> Conclusion <p>The provincial Massive Hemorrhage Protocol toolkit’s dissemination was feasible and associated with increased adoption in Ontario hospitals. Two-years post rollout, 77% of provincial hospitals have Massive Hemorrhage Protocols in place. Opportunities remain to align contents with evidence-based recommendations and expand to remaining hospitals. This strategy could guide other jurisdictions to improve Massive Hemorrhage Protocol adoption and harmonize practices.</p>

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Massive Hemorrhage Protocol adoption and standardization with a provincial toolkit: a follow-up survey of Ontario hospitals

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2025年5月22日

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  • Chantalle L. Grant,
  • Omar I. Hajjaj,
  • Kimmo Murto,
  • Stephanie Cope,
  • Andrew Petrosoniak,
  • Troy Thompson,
  • Katerina Pavenski,
  • Jeannie L. Callum

摘要

Purpose

Massive Hemorrhage Protocols improve outcomes for adults with severe hemorrhage, yet only 65% of Ontario hospitals had implemented one by 2018. In response, a Massive Hemorrhage Protocol toolkit was developed and disseminated province-wide in 2021. This study compares Massive Hemorrhage Protocol adoption and content in Ontario hospitals in 2023 versus 2018 using a pre- and post-toolkit rollout survey.

Methods

A 98-question survey was emailed to transfusion medicine laboratory directors or their delegate at 159 hospitals in 2023, 2 years after a provincial Massive Hemorrhage Protocol toolkit rollout that included a 1-day virtual symposium. Results were compared with the 2018 survey containing 82 identical core questions using Chi-square test, Fisher exact test, and Wilcoxon rank-sum nonparametric tests for quantitative data, and content analysis for qualitative data.

Results

The 2023 survey achieved a 100% response rate (n = 159); most respondents (n = 156) were transfusion staff. Hospitals with a Massive Hemorrhage Protocol increased significantly from 65% (n = 150) in 2018 to 77% (n = 159) in 2023 (p = 0.02). Small transfusion hospitals (< 5000 red blood cell units transfused/year) saw an increase in Massive Hemorrhage Protocol adoption from 60 to 74% (p = 0.02). By 2023, 95% (n = 159) of hospitals had/were implementing a Massive Hemorrhage Protocol. However, gaps in alignment to evidence-based recommendations remained, including hypothermia monitoring (missing in 25% of Massive Hemorrhage Protocols) tranexamic acid dosing (missing in 19%), and quality metric tracking (missing in 55%). Pediatric content was absent in 45% of Massive Hemorrhage Protocols in health centers caring for children.

Conclusion

The provincial Massive Hemorrhage Protocol toolkit’s dissemination was feasible and associated with increased adoption in Ontario hospitals. Two-years post rollout, 77% of provincial hospitals have Massive Hemorrhage Protocols in place. Opportunities remain to align contents with evidence-based recommendations and expand to remaining hospitals. This strategy could guide other jurisdictions to improve Massive Hemorrhage Protocol adoption and harmonize practices.