This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a colleague Similar articles in this journal Similar articles in Web of Science Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via Web of Science (1) Citing Articles via Google Scholar Google Scholar Articles by Gonano, C. Articles by Zimpfer, M. Search for Related Content PubMed PubMed Citation Articles by Gonano, C. Articles by Zimpfer, M. Related Collections Economics and Health Care Research Blood

---

ECONOMICS, EDUCATION, AND HEALTH SYSTEMS RESEARCH

Educational or Organizational Approach: Which Is More Effective in Changing Blood-Sampling Habits?

Christopher Gonano, MD^*,, Christian Sitzwohl, MD^*, Franz Pusch, MD^*, Stephan C. Kettner, MD^*,, Christian Weinstabl, MD^*, and Michael Zimpfer, MD MBA^*,

*Department of Anesthesiology and General Intensive Care, University of Vienna, Vienna, Austria; and Ludwig Boltzmann Institute of Clinical Anesthesiology and Intensive Care, Vienna, Austria

Address correspondence and reprint requests to Christopher Gonano, MD, Department of Anesthesiology and General Intensive Care, General Hospital of Vienna, A-1090 Vienna, Waehringer Guertel 18-20. Address e-mail to christopher.gonano{at}univie.ac.at

Diagnostic blood loss is a recognized issue during the delivery of intensive care services. We designed this study to compare the effects of educational versus organizational approaches to reduce daily diagnostic blood loss in intensive care patients. First, as an educational approach, physicians on two wards were repeatedly informed about the importance of diagnostic blood loss and that 1.0–1.5 mL is sufficient for blood gas analysis. Second, as an organizational approach, 3-mL syringes were replaced by 2-mL syringes. Measurements after both periods were compared with a control group. The amount of drawn/discarded blood of 320 samples was measured in each group after the 2 interventions. Compared with the control group, the educational program reduced the amount of drawn/discarded blood in one ward, but not the other. After the organizational change, the amount of drawn/discarded blood was reduced in both wards. Additionally, because of the smaller costs of 2-mL syringes, implementation of 2-mL syringes saved US$30,800/yr in our hospital. In conclusion, our study shows that an educational program seems less effective in influencing physician behavior than organizational changes. Therefore, organizational changes should be favored over educational approaches whenever possible.

IMPLICATIONS: Organizational change is more effective than educational programs to reduce diagnostic blood loss. Organizational implementation of smaller syringes reduces the amount of discarded blood and can save money.