DETERMINANTS OF PHYSICIAN ORDERING OF PREOPERATIVE AUTOLOGOUS DONATIONS

Preoperative autologous donation (PAD) is frequently utilized to reduc e infectious disease transmission risks, but it is an expensive form o f hemotherapy that is not always closely matched with the needs of the patients. We compared the use of PAD in an academic medical center wi th patient needs and then investigated the efficacy of a simple interv ention to promote targeting of PAD toward patients most likely to bene fit from having PADs available. Over a 3-month period, surgeons whose patients received allogeneic components were asked to complete a quest ionnaire designed to identify reasons for not ordering PAD. PAD units were used in 14 (11%) of 124 cases, accounting for 6% of perioperative red cell use. The responses (46, 42% of the surveys sent) stated that PAD had not been ordered because of time constraints (39%), medical p roblems (26%), anemia (15%), and lack of expectation of blood use (24% ). Chart review documented the presence of cited conditions in 88% of cases. Logistic and cost concerns were not evident. However, only 8% o f the 176 PAD units collected in that period were transfused. Followin g dissemination of PAD ordering guidelines, this proportion rose to 52 % without a reduction in the proportion of elective surgical cases uti lizing autologous transfusion. This improvement in ordering practice w as maintained over at least in 5-month period. Thus we were able to im prove the efficiency of PAD application (reducing over-ordering) throu gh a simple feedback to surgeons that assisted them in targeting PAD t oward patients most likely to need transfusion.