Adding a caveat to the urgent clinical notification of anaemia does not reduce inappropriate emergency room referral rates

Urgent clinician notification of low haemoglobin values might influence the clinicians' decision to refer patients to the emergency room (ER).


We compared the effects of urgent clinician notification for low haemoglobin values with and without an added statement, that an urgent visit to the ER is not required if the patient has a haemoglobin value of 50 g/l or more and is clinically stable. We compared the referral rates and outcomes of 100 consecutive cases reported previously to that of 99 consecutive new cases with the added caveat.


Overall 47 (47%) of the historical control patients were referred to the ER compared with 45 (45.5%) in the study group (relative risk, 0.97, 95% CI, 0.72-1.3). Five patients were inappropriately transfused and almost none of the ER visits were an emergency.


Adding a caveat to the urgent clinician notification that anaemia in clinically stable patients is not a medical emergency does not decrease the rate of ER referrals. Further studies are needed in order to find ways to decrease the number of inappropriate ER referrals.


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Froom P
Grikshtas R
Havis R
Barak M