THE EFFECT OF PROVIDER EDUCATION ON BLOOD UTILIZATION PRACTICES

OBJECTIVE: Our aim was to determine prospectively if a process of prov ider education and subsequent audit of transfusion criteria can reduce inappropriate blood product infusion. STUDY DESIGN: Beginning in Dece mber 1990, a year-long process of provider education and quality assur ance audit, with the use of guidelines based on National Institutes of Health blood product consensus conferences, was instituted. After thi s orientation and education period, the medical records were reviewed for patients on the obstetrics and gynecology service from Dec. 1, 199 0, through Sept. 30, 1991, who received blood products (packed red blo od cells, fresh-frozen plasma, cryoprecipitate). This group was compar ed with patients cared for by our service over a similar period before the institution of these guidelines. The incidence of cesarean birth and operative intervention for gynecologic malignancies, as well as th e number of major operative gynecologic procedures, was found to be un changed during the total study period (Dec. 1, 1988, through Sept. 30, 1991). RESULTS: In 1989 there were 1236 units of blood products trans fused; in contrast, in 1991 428 units of blood were transfused. In 198 9, 107.9 +/- 59.9 units of packed cells per month were used in 33.6 +/ - 16.8 patients (3.2 units per patient). In contrast, in 1991, 14.4 +/ - 5.8 patients per month received transfusions (2.82 units per patient ) with 40.7 +/- 17.2 units of packed cells (p < 0.0001). This represen ts a 75% decrease in the total number of packed cells and a 60% decrea se in the number of patients undergoing transfusion per month. Similar reductions in the usage of cryoprecipitate and fresh-frozen plasma we re noted (p = 0.024 and 0.002, respectively). Acute operative blood lo ss was the most common indication for transfusion. Abdominal hysterect omy was the most common procedure followed by exploratory laparotomy a nd cesarean section. No patients in whom blood was not used had untowa rd effects. CONCLUSION: Education as to appropriate blood utilization and concurrent quality assurance audit techniques can safely reduce bl ood usage on a busy obstetrics and gynecology service in a tertiary ca re center.