EFFECTIVENESS OF A PROSPECTIVE PHYSICIAN SELF-AUDIT TRANSFUSION-MONITORING SYSTEM

BACKGROUND: The purpose of this study was to search for a more effecti ve transfusion-monitoring system than the existing system of retrospec tive peer review. STUDY DESIGN AND METHODS: This research used a study -control, preintervention and postintervention design, to evaluate the effectiveness of a prospective physician self-audit transfusion-monit oring system that functioned without the direct involvement of transfu sion service physicians. This research also evaluated the effectivenes s of issuing to physicians a memo with transfusion guidelines. Three p rocess indicators were used to assess physician behavior at various st ages of the blood-ordering process: 1) the number of crossmatches orde red per admission, 2) the transfusion-to-crossmatch ratio, and 3) the number of blood units returned to the laboratory after physician self- auditing. The study used two outcome indicators to reflect overall blo od utilization: 1) the percentage of patients who received red cell tr ansfusions and 2) the number of blood units transfused per recipient e ach month. RESULTS: Tile prospective physician self-audit system imple mented at the study hospital did not reverse physician transfusion dec isions, and the process of issuing to physicians a memo with transfusi on guidelines at the control hospital failed to reduce blood usage. Ho wever, a transient reduction in blood utilization was observed at the study hospital. CONCLUSION: The reduction was hypothesized to be due t o a Hawthorne effect, in which observed behavior is affected by the su bject's awareness of the research study.