Effect of a flow chart on use of blood transfusions in primary total hip and knee replacement: prospective before and after study

摘要

Problem A suspected high proportion of unnecessary blood transfusions occur in patients undergoing total joint replacement.Design Prospective before and after study evaluating the impact of a one page flow chart aimed at reducing the use of blood transfusions.Setting Orthopaedic tertiary care centre in Winterthur, Switzerland. 208 patients underwent primary total joint replacement of hips or knees during the control period (October 1998 to September 1999) and 217 during the intervention period (October 1999 to September 2000).Key measures for improvement Proportion of patients receiving allogeneic blood transfusions.Strategies for change A simple one page flow chart, which summarised graphically the perioperative decision pathways for anaemic patients, was placed in all charts of patients undergoing total joint replacement and handed out to medical staff from 4 October 1999 onwards. The implementation of the flow chart focused on its endorsement by chief physicians and the development of a sense of "ownership" among physicians and nurses.