Evidence map›Paper›PMID 40402339›Full record

ArticleCJEM2025

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

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

Abstract readMulticenter Study
PubMed Full text at PMC Publisher
In one paragraph

Article in CJEM, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 3 papers.

0numbers the graph read from it
0cells of the map it votes in
3citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

3 citing papers in PubMed.

  1. Article
  2. Article
  3. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

8 authors.

Chantalle L GrantDepartment of Surgery, Trauma Services Office, University of British Columbia, Vancouver General Hospital, Vancouver, BC, Canada. chantalle.grant@vch.ca.ORCID 0000-0003-4726-8242
Omar I HajjajDepartment of Medicine, Queen's University, Kingston, ON, Canada.ORCID 0000-0003-4292-3105
Kimmo MurtoDepartment of Anesthesiology & Pain Medicine, CHEO Research Institute, University of Ottawa, Ottawa, ON, Canada.ORCID 0000-0001-6854-7326
Stephanie CopeOntario Regional Blood Coordinating Network (ORBCoN), Toronto, ON, Canada.
Andrew PetrosoniakDepartment of Medicine, University of Toronto, Toronto, ON, Canada.ORCID 0000-0001-6252-1192
Troy ThompsonOntario Regional Blood Coordinating Network (ORBCoN), Toronto, ON, Canada.
Katerina PavenskiDepartment of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada.ORCID 0000-0001-6700-5197
Jeannie L CallumDepartment of Pathology and Molecular Medicine, Queen's University, Kingston, ON, Canada.ORCID 0000-0001-6133-0677

Funding

Ontario Ministry of Health
6 · The paper itself

Abstract

purposeMassive 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.

methodsA 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.

resultsThe 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.

conclusionThe 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.

Indexed as

Blood TransfusionClinical ProtocolsHemorrhageHospitalsFollow-Up StudiesHumansOntarioSurveys and QuestionnairesImplementationMassive Hemorrhage ProtocolPatient Blood ManagementTransfusionTrauma

Identifiers

PMID40402339
PMCPMC12380861

What OpenQuestion holds

Textmetadata
LicenceCC BY
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.