title: Adequacy of physician documentation and correlation with assessment of transfusion appropriateness: a follow-up study in the setting of prospective audits and patient blood management.
abstract: A previous study in our hospitals correlated suboptimal documentation and failure to justify transfusions. In light of implemented blood-conservation strategies, including patient blood management (PBM) and prospective audits (PAs), we performed a follow-up study.
  
  
  
  We reviewed prospectively audited red blood cell (RBC) transfusions received by adult patients from January to July 2014. Survey forms were used to assess the level of documentation and to classify documentation as adequate, intermediate, or inadequate. Transfusions were deemed justified or not by comparisons with hospital transfusion guidelines. We also analyzed the effect of implemented blood-conservation strategies on our hospital transfusion rates and costs from 2009 to 2015.
  
  
  
  During the study period, there were 259 prospectively audited transfusion events (TEs) (one or more RBC units transfused to a patient), of which we reviewed 94 TEs (36.3%) in 87 patients. TEs with suboptimal (intermediate and inadequate) documentation accounted for 46.8% of the reviewed TEs, of which 81.8% could not be justified compared with 18.0% of nonjustified, adequately documented TEs. The correlation between suboptimal documentation and failure to justify transfusion was significant (p < 0.001). This correlation remained even in a comparison between the site with a PBM program and the sites without such a program. Overall transfusion rates declined after the introduction of PA, although the decline was only statistically significant at the sites with a PBM program.
  
  
  
  Suboptimal transfusion documentation remains problematic and is highly correlated with nonjustifiable transfusions. Newly adopted approaches to minimize blood transfusions have not improved transfusion documentation and corresponding out-of-guideline transfusions, although overall transfusions have been reduced by PA, particularly in the setting of a PBM program.
authors.affiliation: Department of Diagnostic Pathology and Laboratory Medicine, Mount Sinai Health System, New York, New York.
authors.forename: Emilio
authors.initials: E
authors.lastname: Madrigal
authors.affiliation: Department of Diagnostic Pathology and Laboratory Medicine, Mount Sinai Health System, New York, New York.
authors.forename: Shyam
authors.initials: S
authors.lastname: Prajapati
authors.affiliation: Department of Pathology and Laboratory Medicine, Emory University, Atlanta, Georgia.
authors.forename: Vaidehi
authors.initials: V
authors.lastname: Avadhani
authors.affiliation: Transfusion Medicine, Mount Sinai Beth Israel, New York, New York.
authors.forename: Kyle
authors.initials: K
authors.lastname: Annen
authors.affiliation: Department of Diagnostic Pathology and Laboratory Medicine, Mount Sinai Health System, New York, New York.
authors.forename: Mark T
authors.initials: MT
authors.lastname: Friedman
mesh_terms: D000293:Adolescent; D000328:Adult; D003365:Costs and Cost Analysis; D017707:Erythrocyte Transfusion / Q000191:economics* / Q000592:standards*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008485:Medical Audit; D008499:Medical Records / Q000191:economics* / Q000592:standards*; D008875:Middle Aged; D011446:Prospective Studies