Appropriateness of red blood cell transfusions in major urban hospitals and effectiveness of an intervention.
OBJECTIVE
To assess the appropriateness of red blood cell (RBC) transfusions and the effectiveness of an intervention to reduce inappropriate RBC transfusions.


METHODS
Medical record audit by hospital staff using a data form, before and after randomly allocated interventions (letter only or letter+visit). Criteria for assessing appropriateness of RBC transfusions were based on a systematic literature review.


METHODS
Ten major urban hospitals in Sydney, New South Wales, in 1998 and 1999.


METHODS
Medical records of up to 120 patients at each hospital (n=1117).


METHODS
Letter-only (5 hospitals)--results of first audit at the hospital mailed to chief executive officer of that hospital; letter+visit (5 hospitals) results of first audit at the hospital presented by the research team to a meeting of that hospital's staff, and then mailed to the chief executive officer.


METHODS
Proportion of RBC transfusions assessed as inappropriate.


RESULTS
At first audit, 35% of RBC transfusions were assessed as inappropriate. Small reductions in inappropriate transfusions were found at the second audit, but the change was significant only for the hospitals receiving the letter-only intervention. About 5% of patients received a single RBC unit; 40% of single-unit transfusions were inappropriate. More RBC transfusions were inappropriate in surgical patients than in those treated by other specialties.


CONCLUSIONS
About a third of RBC transfusions were assessed as inappropriate. The interventions had only a small effect on transfusion appropriateness.
Rubin
G L
GL
Department of Public Health and Community Medicine, University of Sydney at Westmead, NSW. grubin@med.usyd.edu.au
Schofield
W N
WN
Dean
M G
MG
Shakeshaft
A P
AP
D000368:Aged; D001315:Australia; D016001:Confidence Intervals; D003657:Decision Making; D017707:Erythrocyte Transfusion / Q000706:statistics & numerical data*; D005260:Female; D006402:Hematologic Diseases / Q000175:diagnosis / Q000628:therapy; D006786:Hospitals, Urban / Q000592:standards*; D006801:Humans; D008297:Male; D008485:Medical Audit; D008875:Middle Aged; D011336:Probability; D012042:Registries; D012680:Sensitivity and Specificity; D019564:Unnecessary Procedures; D014505:Urban Population; D014947:Wounds and Injuries / Q000175:diagnosis / Q000628:therapy