title: Effectiveness of a prospective physician self-audit transfusion-monitoring system.
abstract: BACKGROUND
  The purpose of this study was to search for a more effective transfusion-monitoring system than the existing system of retrospective peer review.
  
  
  METHODS
  This research used a study-control, preintervention and postintervention design, to evaluate the effectiveness of a prospective physician self-audit transfusion-monitoring system that functioned without the direct involvement of transfusion service physicians. This research also evaluated the effectiveness of issuing to physicians a memo with transfusion guidelines. Three process indicators were used to assess physician behavior at various stages of the blood-ordering process: 1) the number of crossmatches ordered per admission, 2) the transfusion-to-crossmatch ratio, and 3) the number of blood units returned to the laboratory after physician self-auditing. The study used two outcome indicators to reflect overall blood utilization: 1) the percentage of patients who received red cell transfusions and 2) the number of blood units transfused per recipient each month.
  
  
  RESULTS
  The prospective physician self-audit system implemented at the study hospital did not reverse physician transfusion decisions, and the process of issuing to physicians a memo with transfusion guidelines at the control hospital failed to reduce blood usage. However, a transient reduction in blood utilization was observed at the study hospital.
  
  
  CONCLUSIONS
  The reduction was hypothesized to be due to a Hawthorne effect, in which observed behavior is affected by the subject's awareness of the research study.
authors.affiliation: School of Public Health, University of California, Los Angeles, USA.
authors.forename: H T
authors.initials: HT
authors.lastname: Lam
authors.forename: S O
authors.initials: SO
authors.lastname: Schweitzer
authors.forename: L
authors.initials: L
authors.lastname: Petz
authors.forename: M H
authors.initials: MH
authors.lastname: Kanter
authors.forename: D A
authors.initials: DA
authors.lastname: Bernstein
authors.forename: S
authors.initials: S
authors.lastname: Brauer
authors.forename: D V
authors.initials: DV
authors.lastname: Pascual
authors.forename: B A
authors.initials: BA
authors.lastname: Myhre
authors.forename: I A
authors.initials: IA
authors.lastname: Shulman
authors.forename: G W
authors.initials: GW
authors.lastname: Sun
mesh_terms: D001788:Blood Grouping and Crossmatching; D001803:Blood Transfusion / Q000592:standards*; D006801:Humans; D010380:Peer Review / Q000592:standards; D011446:Prospective Studies; D012189:Retrospective Studies