HOSPITAL-WIDE EDUCATIONAL-PROGRAM DECREASES RED-BLOOD-CELL TRANSFUSIONS

Background. Because of the numerous risks associated with the use of p acked red blood cells (RBCs), it is critical that they be transfused o nly when appropriate. A hospital-wide educational program was develope d in an attempt to improve the transfusion practices and provide a fra mework for blood bank audit at a Veterans Affairs teaching hospital. M aterials and methods. The program required physicians to fill out an i nformation sheet that listed appropriate criteria for transfusion. Cha rts were reviewed to determine if the transfusion met these criteria. If the transfusion was deemed inappropriate by peer review, the staff physician was notified by letter. The information sheet was used on a voluntary basis without chart review in 1989 and on a mandatory basis beginning in 1990. Transfusion rates and mortality were adjusted to pa tient days of hospitalization and evaluated using chi(2) analysis. Res ults. While voluntary use did not affect transfusion rate, mandatory i mplementation resulted in a 26% decline (P < 0.001) between 1989 and 1 990 in the number of RBC units transfused per patient days of hospital ization. A diminished use of RBCs persisted in the subsequent years. T here was no increase in mortality during this time to suggest a detrim ental effect from the decrease in RBC transfusion. No apparent variati on in the hospital population could account for the changes. Conclusio n. Use of a unique and simple transfusion request sheet as an educatio nal tool resulted in improved transfusion practices at a Veteran Affai rs teaching hospital. (C) 1998 Academic Press.