THE TRANSFUSION AUDIT AS A TOOL TO IMPROVE TRANSFUSION PRACTICE - A CRITICAL-APPRAISAL

Transfusion audits have a long history and they are required by many r egulatory agencies. These audits have been touted as effective in redu cing unnecessary transfusions as evidenced by many published articles on the subject. Most of these studies, however, have one or more flaws in their design including the use of historical controls, disregard o f the Hawthorne effect, use of multiple interventions, and publication bias. Studies differ in the baseline rate of inappropriate transfusio ns and have different methods of measuring these rates. There is also little data on how long the effect of implementing a transfusion audit system may last. Transfusion audits appear most successful when there is a high baseline rate of inappropriate transfusions and interventio ns other than the audit itself are performed. Individual institutions should critically evaluate whether or not their current system of tran sfusion audits is useful. (C) 1998 Elsevier Science Ltd. All rights re served.