title: Improving appropriateness of blood utilization through prospective review of requests for blood products: the role of pathology residents as consultants.
abstract: OBJECTIVE
  To evaluate the effectiveness of prospective review of orders for fresh-frozen plasma (FFP) and platelets in reducing blood-product use, and of the effectiveness of preparing pathology residents to serve as clinical consultants.
  
  
  METHODS
  At our 572-bed tertiary-care hospital, we developed guidelines for the use of blood products in collaboration with a variety of departments. For patients whose condition(s) met generally accepted criteria, we identified trigger points to allow for quick release by blood bank staff of blood products. For patients whose condition(s) did not meet the applicable criteria, the on-call pathology resident reviewed the medical record of that patient to determine whether there were any extenuating circumstances; consulted with the ordering physician and attending pathologist, as needed; and advised the house staff on appropriate use of blood products. We evaluated the change in use of blood products between the years 2009 and 2012 to assess the effectiveness of the program.
  
  
  RESULTS
  We observed a decrease of 38.8% and 31.4% in the use of FFP and platelets, respectively (29.7% and 21.1%, respectively, when normalized for the number of discharges). If projected to the national level, this improvement would translate to an annual cost reduction of approximately $130 million.
  
  
  CONCLUSIONS
  Prospective review of orders for blood products can significantly improve use of these products, thereby reducing risk to patients and avoiding unnecessary healthcare costs. The involvement of pathology residents in the prospective review process provides an excellent opportunity for their training as laboratory consultants.
authors: Department of Pathology, University of Missouri-Kansas City lindsey.haldiman@tmcmed.org.
authors: Lindsey
authors: L
authors: Haldiman
authors: Department of Pathology, University of Missouri-Kansas City.
authors: Hamid
authors: H
authors: Zia
authors: Department of Pathology, University of Missouri-Kansas City.
authors: Gurmukh
authors: G
authors: Singh
mesh_terms: D001803:Blood Transfusion / Q000706:statistics & numerical data*; D006801:Humans; D007396:Internship and Residency; D010336:Pathology / Q000193:education*; D011446:Prospective Studies
keywords: appropriateness of utilization; clinical pathology consultation; fresh frozen plasma; patient safety