title: Role of quality improvement in prevention of inappropriate transfusions.
abstract: OBJECTIVE
  Many different methods are used to manage surgical bleeding and reduce transfusion. Techniques vary by institution, resulting in inconsistent outcomes. We reviewed the current literature on the quality and costs of transfusions, focusing on prevention and management of transfusions during surgery, and provide recommendations on future directions for quality improvement (QI).
  
  
  METHODS
  Ovid, PubMed, and Scopus.
  
  
  METHODS
  Key words included QI, blood loss, transfusion, hemostasis, and costs. Inclusion criteria were English language, publication between 1999 and 2010, and primary end points of blood loss, transfusion, or hemostasis.
  
  
  METHODS
  A total of 1331 abstracts were reviewed; 43 met the inclusion criteria.
  
  
  RESULTS
  A variety of bleeding management (BM) techniques were identified, with multiple studies suggesting that algorithms combining pre-, peri-, and postoperative interventions have the greatest potential to minimize transfusions. Most studies assessing the economic impact of BM interventions excluded resources beyond blood acquisition cost and longer-term complications, which may underestimate transfusion costs and bias estimates of the cost-effectiveness of interventions. Despite consensus on avoiding inappropriate transfusions, little agreement exists on optimal use of interventions.
  
  
  CONCLUSIONS
  Multifaceted algorithms show promising results. Future QI should focus on reducing practice variation via evidence-based guidelines for effective use of BM interventions.
authors.affiliation: Jefferson School of Population Health, Thomas Jefferson University, Philadelphia, Pennsylvania 19107, USA. anita.mohandas@gmail.com
authors.forename: Anita
authors.initials: A
authors.lastname: Mohandas
authors.forename: Kathleen A
authors.initials: KA
authors.lastname: Foley
authors.forename: David B
authors.initials: DB
authors.lastname: Nash
authors.forename: Cataldo
authors.initials: C
authors.lastname: Doria
mesh_terms: D016063:Blood Loss, Surgical; D001803:Blood Transfusion / Q000191:economics / Q000379:methods* / Q000706:statistics & numerical data; D003365:Costs and Cost Analysis; D006801:Humans; D017410:Practice Guidelines as Topic; D058996:Quality Improvement / Q000191:economics / Q000458:organization & administration*