ROLE OF QUALITY ASSESSMENT IN IMPROVING RED-BLOOD-CELL TRANSFUSION PRACTICE

A prospective analysis of perioperative red blood cell transfusion pra ctice in 110 patients undergoing elective primary total hip arthroplas ty was conducted as a part of a quality assessment programme at the Na tional Orthopaedic Hospital. In addition to demographic and clinical d ata, blood loss and perioperative transfusions were also recorded, Blo od was collected for evaluation of haematocrit levels at predetermined intervals (preoperative and 6 h, 1, 2, 3, 7 days, postoperatively). B lood transfused with the patient's haematocrit of more than 30 per cen t was considered inappropriate, In addition, a discharge haematocrit e xceeding 36 per cent was chosen to identify overtransfusion. Eighty-fo ur per cent were transfused a total of 191 units of homologous blood, Only 4 units were transfused between 3 patients, intraoperatively, All intraoperative transfusions were appropriate, Using the preset criter ia (i.e. blood transfused with haematocrit of more than 30 per cent), 36 per cent of total units transfused were inappropriate, Using the cr iterion of discharge haematocrit of more than 36 per cent, 24 per cent of the patients were overtransfused. As compared to a previous retros pective analysis of blood transfusion in the same patient population w hich showed that inappropriate transfusion occurred in 45 per cent of the patients, the results from this study suggest a trend towards a mo re conservative transfusion practice, The improvement in transfusion p ractice may be due to the ongoing quality assurance programme and the use of transfusion guidelines.