Appropriateness of red blood cell transfusions in major urban hospitals and effectiveness of an intervention.

Abstract

OBJECTIVES: To assess the appropriateness of red blood cell (RBC) transfusions and the effectiveness of an intervention to reduce inappropriate RBC transfusions. DESIGN: Medical record audit by hospital staff using a data form, before and after randomly allocated interventions (letter only or letter+visit). Criteria for assessing appropriateness of RBC transfusions were based on a systematic literature review. SETTING: Ten major urban hospitals in Sydney, New South Wales, in 1998 and 1999. SUBJECTS: Medical records of up to 120 patients at each hospital (n=1117). INTERVENTIONS: Letter-only (5 hospitals)--results of first audit at the hospital mailed to chief executive officer of that hospital; letter+visit (5 hospitals) results of first audit at the hospital presented by the research team to a meeting of that hospital's staff, and then mailed to the chief executive officer. MAIN OUTCOME MEASURE: Proportion of RBC transfusions assessed as inappropriate. RESULTS: At first audit, 35% of RBC transfusions were assessed as inappropriate. Small reductions in inappropriate transfusions were found at the second audit, but the change was significant only for the hospitals receiving the letter-only intervention. About 5% of patients received a single RBC unit; 40% of single-unit transfusions were inappropriate. More RBC transfusions were inappropriate in surgical patients than in those treated by other specialties. CONCLUSIONS: About a third of RBC transfusions were assessed as inappropriate. The interventions had only a small effect on transfusion appropriateness.