title: The appropriateness of blood transfusion following primary total hip replacement.
abstract: BACKGROUND
  A significant proportion of all red cell transfusions are given to patients undergoing elective orthopaedic surgery. Concern over transfusion safety and cost, coupled with evidence showing that restrictive transfusion policies benefit patients, prompted us to audit our  blood prescribing practice at Gloucestershire Hospitals NHS Foundation Trust in order to assess the appropriateness of every transfusion episode following elective primary total hip replacement.
  
  
  METHODS
  All patients undergoing a primary total hip replacement in our department over a six-month  period were included in the study. Data were collected retrospectively using case note examination and transfusion service data. Standards were dictated by the British Orthopaedic Association guidelines on blood conservation in elective orthopaedic surgery.
  
  
  RESULTS
  Twenty-seven per cent of  patients (39/143) were transfused. Forty-six per cent of these (18/39) were transfused inappropriately and twenty-three per cent (9/39) appropriately. Thirteen per cent (5/39) had a valid indication for transfusion but were over-transfused and in eighteen per cent (7/39) the quality of documentation  did not allow an assessment to be made. Fifty-two per cent of patients who had surgical drains (29/56) were transfused. Reaudit following staff education and amendments to the local transfusion policy did not demonstrate a reduction in transfusion rates.
  
  
  CONCLUSIONS
  This audit showed that  significant potential exists for reducing transfusion rates based on optimising prescribing practice alone. It also demonstrated that changing local practice based on audit data can be challenging.
authors.affiliation: Gloucestershire Hospitals NHS Foundation Trust, UK. paula_joy@hotmail.co.uk
authors.forename: P J
authors.initials: PJ
authors.lastname: Joy
authors.forename: S J
authors.initials: SJ
authors.lastname: Bennet
mesh_terms: D000740:Anemia / Q000517:prevention & control; D019644:Arthroplasty, Replacement, Hip / Q000191:economics / Q000706:statistics & numerical data*; D001803:Blood Transfusion / Q000191:economics / Q000706:statistics & numerical data*; D006454:Hemoglobins / Q000378:metabolism; D006801:Humans; D008485:Medical Audit; D011182:Postoperative Care / Q000191:economics / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D019564:Unnecessary Procedures / Q000191:economics / Q000706:statistics & numerical data
chemical_list: D006454:Hemoglobins