Transfusion Therapycolon; Improved Patient Care and Resource Utilization

摘要

In an attempt to improve the quality of medical care while reducing cost at a 1020-bed, tertiary-care, teaching hospital, the Transfusion Committee modified transfusion practice by establishing new transfusion guidelines based upon national standards rather than local practices and by implementing educational and monitoring systems.The transfusion committee subsequently implemented a monitoring system requiring physicians to record medical indications for all nonemergency transfusions. Separate systems were necessary for nonoperative and intraoperative transfusions.During the first few months, all indications were reviewed by a transfusion committee member. Copies of obviously inappropriate or inadequate indications such as ldquo;low countrdquo; or ldquo;intensive carerdquo; were sent to the ordering physician with an explanatory letter. After hospital staff adjusted to the system, the transfusion committee began reviewing the appropriateness of indications, focusing on all free-text indications entered. A transfusion committee member initially reviewed these to determine which ones required additional information. If, after several information exchanges and review of the chart by the quality assurance staff, the data did not justify the transfusion, a letter was sent to the physician explaining the committee's position.The anesthesiologists recorded the medical indications for the intraoperative transfusions at the time of transfusion on a form accompanying each unit of blood sent to the operating suites. All forms were reviewed by the transfusion committee, and letters were sent to the anesthesiologist if the committee did not agree with the recorded indication.The transfusion guidelines were formulated and adopted during fiscal year (FY) 90. The monitoring system was implemented in FY 91. FY 89 was selected as the baseline for comparison purposes because the transfusion committee was initially organized at the end of that year. The impact of the new system was substantial, as detailed in Table 1. The new transfusion guidelines were able to effect substantial cost and patient risk reductions during this 3-year period, even though hospital services affecting blood transfusion increased.