title: Appropriateness of red blood cell transfusions in major urban hospitals and effectiveness of an intervention.
abstract: 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.
authors.affiliation: Department of Public Health and Community Medicine, University of Sydney at Westmead, NSW. grubin@med.usyd.edu.au
authors.forename: G L
authors.initials: GL
authors.lastname: Rubin
authors.forename: W N
authors.initials: WN
authors.lastname: Schofield
authors.forename: M G
authors.initials: MG
authors.lastname: Dean
authors.forename: A P
authors.initials: AP
authors.lastname: Shakeshaft
mesh_terms: 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