Appropriateness of red blood cell transfusions in major urban hospitals and effectiveness of an intervention

Objectives: To assess the appropriateness of red blood cell (RBC) transfusi ons and the effectiveness of an intervention to reduce inappropriate RBC tr ansfusions. Design: Medical record audit by hospital staff using a data form, before an d after randomly allocated interventions (letter only or letter+visit). Cri teria for assessing appropriateness of RBC transfusions were based on a sys tematic literature review. Setting: Ten major urban hospitals in Sydney, New South Wales, in 1998 and 1999. Subjects: Medical records of up to 120 patients at each hospital (n = 1117). Interventions: Letter-only (5 hospitals) - results of first audit at the ho spital mailed to chief executive officer of that hospital; letter+visit (5 hospitals) results of first audit at the hospital presented by the research team to a meeting of that hospital's staff, and then mailed to the chief e xecutive officer. Main outcome measure: Proportion of RBC transfusions assessed as inappropri ate. Results: At first audit, 35% of RBC transfusions were assessed as inappropr iate. Small reductions in inappropriate transfusions were found at the seco nd audit, but the change was significant only for the hospitals receiving t he letter-only intervention. About 5% of patients received a single RBC uni t; 40% of single-unit transfusions were inappropriate. More RBC transfusion s were inappropriate in surgical patients than in those treated by other sp ecialties. Conclusions: About a third of RBC transfusions were assessed as inappropria te. The interventions had only a small effect on transfusion appropriatenes s.