title: Variability in blood and blood component utilization as assessed by an anesthesia information management system.
abstract: BACKGROUND
  Data can be collected for various purposes with anesthesia information management systems. The authors describe methods for using data acquired from an anesthesia information management system to assess intraoperative utilization of blood and blood components.
  
  
  METHODS
  Over an 18-month period, data were collected on 48,086 surgical patients at a tertiary care academic medical center. All data were acquired with an automated anesthesia recordkeeping system. Detailed reports were generated for blood and blood component utilization according to surgical service and surgical procedure, and for individual surgeons and anesthesiologists. Transfusion hemoglobin trigger and target concentrations were compared among surgical services and procedures, and between individual medical providers.
  
  
  RESULTS
  For all patients given erythrocytes, the mean transfusion hemoglobin trigger was 8.4 ± 1.5, and the target was 10.2 ± 1.5 g/dl. Variation was significant among surgical services (trigger range: 7.5 ± 1.2-9.5 ± 1.1, P = 0.0001; target range: 9.1 ± 1.2-11.3 ± 1.4 g/dl, P = 0.002), surgeons (trigger range: 7.2 ± 0.7-9.8 ± 1.0, P = 0.001; target range: 8.8 ± 0.9-11.8 ± 1.3 g/dl, P = 0.001), and anesthesiologists (trigger range: 7.2 ± 0.8-9.6 ± 1.2, P = 0.001; target range: 9.0 ± 0.9-11.7 ± 1.3 g/dl, P = 0.0004). The use of erythrocyte salvage, fresh frozen plasma, and platelets varied threefold to fourfold among individual surgeons compared with their peers performing the same surgical procedure.
  
  
  CONCLUSIONS
  The use of data acquired from an anesthesia information management system allowed a detailed analysis of blood component utilization, which revealed significant variation among surgical services and surgical procedures, and among individual anesthesiologists and surgeons compared with their peers. Incorporating these methods of data acquisition and analysis into a blood management program could reduce unnecessary transfusions, an outcome that may increase patient safety and reduce costs.
authors.affiliation: Department of Anesthesiology/Critical Care Medicine, The Johns Hopkins Medical Institutions, Baltimore, Maryland 21287, USA. sfrank3@jhmi.edu
authors.forename: Steven M
authors.initials: SM
authors.lastname: Frank
authors.forename: Will J
authors.initials: WJ
authors.lastname: Savage
authors.forename: Jim A
authors.initials: JA
authors.lastname: Rothschild
authors.forename: Richard J
authors.initials: RJ
authors.lastname: Rivers
authors.forename: Paul M
authors.initials: PM
authors.lastname: Ness
authors.forename: Sharon L
authors.initials: SL
authors.lastname: Paul
authors.forename: John A
authors.initials: JA
authors.lastname: Ulatowski
mesh_terms: D000758:Anesthesia; D017707:Erythrocyte Transfusion; D006454:Hemoglobins / Q000032:analysis; D006801:Humans; D019451:Information Management; D013514:Surgical Procedures, Operative
chemical_list: D006454:Hemoglobins