EVALUATING THE APPROPRIATENESS OF RED-BLOOD-CELL TRANSFUSIONS - THE LIMITATIONS OF RETROSPECTIVE MEDICAL RECORD REVIEWS

Objective: Several studies have looked at the appropriateness of red b lood cell transfusions, using retrospective chart reviews to assess co mpliance with guidelines, The goal of this study was to determine the quality of medical chart documentation, and assess the validity and th e feasibility of using retrospective chart review data as part of a qu ality improvement (QI) program, to evaluate the appropriateness of per i-operative transfusions, Design: The charts of 188 patients admitted for elective orthopedic surgery were reviewed. Both intra-operative an d post-operative transfusion events (n = 353) were analyzed, Results: Only 68% of post-operative transfusion events on the day of surgery an d 35% of transfusion events on days after surgery were accompanied by documentation of blood loss and/or change in vital signs, Symptoms wer e recorded in only 10% of post-operative transfusion events. The ratio nale for transfusion was recorded in only 16% of post-operative transf usion events on the day of surgery, in 27% on post-operative days and in 95% of intraoperative transfusions. The documentation of rationale was not different for transfusion events involving autologous blood (3 1%) or allogeneic blood (32%). This study provided information on tran sfusion practices, Single unit transfusions occurred in only 47 and 34 % of patients receiving autologous and allogeneic blood, respectively, Only 19% of patients transfused with more than one allogeneic blood u nit were clinically reassessed between blood units, compared to 34% of patients receiving more than one autologous blood unit, We conclude t hat retrospective chart reviews are limited by inadequate documentatio n and may not be the optimal source of information to determine the ap propriateness of a transfusion, Improved methods (e,g. prospective rev iews, or other system-level data collection methods) are needed for QI programs to influence practice, Despite its limitations, the informat ion obtained suggests that current practice could be improved.