title: Reducing red cell transfusion by audit, education and a new guideline in a large teaching hospital.
abstract: Safety concerns combined with the greatly increased costs and difficulties of maintaining the blood supply are major considerations for transfusion services. Previous local surveys demonstrated that hospital blood use at our hospital could be improved. Excessive cross-matching, unnecessary transfusion and high return rates of unused blood were commonplace. Transfusion practice was audited over a 3-month period. An education package with guidelines for transfusion was delivered to all clinician groups within the hospital, over the following 9 months. The audit was repeated exactly 1 year later at the same time period. During the second audit, inpatient hospital numbers increased by 1.02% (from n = 7262 to n = 7336) but no differences in length of stay, cardiovascular morbidity or mortality were demonstrated. Twenty percent (n = 254, 2002; n = 316, 2001) fewer patients received blood, and the number of red cell packs used reduced by 19% (from n = 1093 to n = 880). Total number of patients transfused reduced from 4.4% to 3.5% which, as an absolute difference, is a reduction of 0.9% (CI 0.3-1.5, P = 0.006). The audit, guideline and education package had a major impact on red cell use within the hospital with no adverse effects. Blood use can be improved by the implementation of a suitable education package and guideline. If it is possible to replicate the results of this education programme nationwide, the effect on blood use, with subsequent savings and enhanced patient safety could be significant.
authors.affiliation: Department of Anaesthesia, South Glasgow University Hospitals NHS Trust and University of Glasgow, Glasgow, Scotland, UK. magnus.garrioch@doctors.org.uk
authors.forename: M
authors.initials: M
authors.lastname: Garrioch
authors.forename: J
authors.initials: J
authors.lastname: Sandbach
authors.forename: E
authors.initials: E
authors.lastname: Pirie
authors.forename: A
authors.initials: A
authors.lastname: Morrison
authors.forename: A
authors.initials: A
authors.lastname: Todd
authors.forename: R
authors.initials: R
authors.lastname: Green
mesh_terms: D000465:Algorithms; D003657:Decision Making; D004501:Education, Medical; D017707:Erythrocyte Transfusion / Q000706:statistics & numerical data*; D006784:Hospitals, Teaching / Q000379:methods*; D006801:Humans; D008485:Medical Audit; D017410:Practice Guidelines as Topic; D012606:Scotland