title: A strategy to reduce inappropriate red blood cell transfusion.
abstract: OBJECTIVE
  To evaluate the effectiveness of policies intended to decrease unnecessary packed red cell transfusions.
  
  
  METHODS
  The transfusion records of a 550-bed acute care facility were obtained and two six-month periods, one before and one after the introduction of new transfusion policies, were compared.
  
  
  RESULTS
  Meaningful reductions were seen in crossmatch requests, number of units crossmatched and units transfused. After standardising for rising patient numbers, units transfused per 1000 admissions fell by 28.8%. Units crossmatched fell by slightly more than did units transfused, resulting in lower crossmatch-to-transfusion ratios, and indicating more effective use of resources. Total requests fell while "group-and-screen" requests rose, showing a shift toward more appropriate ordering in the face of increasing workload.
  
  
  CONCLUSIONS
  The transfusion policies have succeeded in curtailing unnecessary transfusion practices. They included the lowering of "transfusion-triggering" haemoglobin levels, registrar or consultant approval of transfusions and enforcement of patient consent and chart documentation of transfusion indications, verified by the laboratory. The surgical blood ordering schedule was reviewed under the overall direction of the transfusion committee. A strong institutional commitment is required to lift the profile of blood transfusion.
authors.affiliation: Department of Anaesthesia, Gold Coast Hospital, Southport.
authors.forename: K
authors.initials: K
authors.lastname: Brandis
authors.forename: B
authors.initials: B
authors.lastname: Richards
authors.forename: A
authors.initials: A
authors.lastname: Ghent
authors.forename: S
authors.initials: S
authors.lastname: Weinstein
mesh_terms: D001788:Blood Grouping and Crossmatching / Q000706:statistics & numerical data; D001803:Blood Transfusion / Q000706:statistics & numerical data*; D003253:Consultants; D006300:Health Services Misuse / Q000706:statistics & numerical data*; D006454:Hemoglobins / Q000032:analysis; D006739:Hospital Administration; D006801:Humans; D007258:Informed Consent; D008485:Medical Audit; D008499:Medical Records; D008505:Medical Staff, Hospital / Q000193:education; D009937:Organizational Objectives; D016134:Organizational Policy; D010343:Patient Admission / Q000706:statistics & numerical data; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D011300:Preoperative Care; D011367:Professional Staff Committees / Q000458:organization & administration; D015397:Program Evaluation; D011446:Prospective Studies; D016526:Workload
chemical_list: D006454:Hemoglobins