The Content of Major Haemorrhage Protocols (MHP) in Public Hospitals Throughout Queensland-Are We Following the Evidence?

Objective:
The National Blood Authority (NBA) provides a Major Haemorrhage Protocol (MHP) template for Australian hospitals to develop and modify an MHP algorithm for their needs. However, it is unclear whether the evidence-based guidance from NBA is utilised by individual facilities. The aims of this study were to: (1) establish the baseline composition of MHP from public hospitals across Queensland and (2) compare content using the NBA algorithm and evidence-based recommendations.

Methods:
An explanatory qualitative design was used. Individual health service MHP were assessed against the NBA algorithm by a minimum of two members of the research team.

Results:
Seventy-eight MHP algorithms were retrieved from 113 hospitals and health facilities within Queensland. 99% (n = 77) of algorithms provided recommendations for red blood cell delivery and fibrinogen replacement. Variations existed on the availability of fresh blood products between hospitals and geographical locations. 90% of algorithms (n = 70) contained activation criteria; 21% (n = 14) incorporated additional non-NBA specific criteria. Less than half of MHP algorithms (n = 30, 40%) contained information regarding the management of critically bleeding paediatric patients.

Conclusion:
There is significant variability in the content of MHP algorithms across Queensland, Australia, despite the availability of evidence-based guidelines for patients who are severely bleeding. Whilst individual health facilities are encouraged to modify MHPs to suit local contexts, the evidence on how to safely accomplish this remains limited and could account for the variations identified in this study. Further guidance is required for hospitals with restricted access to blood products, limited pathology testing capabilities, and who manage critically bleeding paediatric patients.