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Adequacy of physician documentation and correlation with assessment of transfusion appropriateness: a follow-up study in the setting of prospective audits and patient blood management.

Abstract：

BACKGROUND:A previous study in our hospitals correlated suboptimal documentation and failure to justify transfusions. In light of implemented blood-conservation strategies, including patient blood management (PBM) and prospective audits (PAs), we performed a follow-up study. STUDY DESIGN AND METHODS:We reviewed prospectively audited red blood cell (RBC) transfusions received by adult patients from January to July 2014. Survey forms were used to assess the level of documentation and to classify documentation as adequate, intermediate, or inadequate. Transfusions were deemed justified or not by comparisons with hospital transfusion guidelines. We also analyzed the effect of implemented blood-conservation strategies on our hospital transfusion rates and costs from 2009 to 2015. RESULTS:During the study period, there were 259 prospectively audited transfusion events (TEs) (one or more RBC units transfused to a patient), of which we reviewed 94 TEs (36.3%) in 87 patients. TEs with suboptimal (intermediate and inadequate) documentation accounted for 46.8% of the reviewed TEs, of which 81.8% could not be justified compared with 18.0% of nonjustified, adequately documented TEs. The correlation between suboptimal documentation and failure to justify transfusion was significant (p < 0.001). This correlation remained even in a comparison between the site with a PBM program and the sites without such a program. Overall transfusion rates declined after the introduction of PA, although the decline was only statistically significant at the sites with a PBM program. CONCLUSION:Suboptimal transfusion documentation remains problematic and is highly correlated with nonjustifiable transfusions. Newly adopted approaches to minimize blood transfusions have not improved transfusion documentation and corresponding out-of-guideline transfusions, although overall transfusions have been reduced by PA, particularly in the setting of a PBM program.

journal_name

Transfusion

journal_title

Transfusion

authors

Madrigal E,Prajapati S,Avadhani V,Annen K,Friedman MT

doi

10.1111/trf.13917

subject

Has Abstract

pub_date

2017-02-01 00:00:00

pages

367-375

issue

eissn

0041-1132

issn

1537-2995

journal_volume

pub_type

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Adequacy of physician documentation and correlation with assessment of transfusion appropriateness: a follow-up study in the setting of prospective audits and patient blood management.