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Effectiveness of a prospective physician self‐audit transfusion‐ monitoring system
Author(s) -
Lam HwaiTai C.,
Schweitzer Stuart O.,
Petz Lawrence,
Kanter Michael H.,
Bernstein David A.,
Brauer Stanley,
Pascual Delio V.,
Myhre Byron A.,
Shulman Ira A.,
Sun GuoWen
Publication year - 1997
Publication title -
transfusion
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.045
H-Index - 132
eISSN - 1537-2995
pISSN - 0041-1132
DOI - 10.1046/j.1537-2995.1997.37697335151.x
Subject(s) - medicine , audit , emergency medicine , prospective cohort study , blood transfusion , blood bank , medical emergency , intensive care medicine , surgery , management , economics
BACKGROUND: The purpose of this study was to search for a more effective transfusion‐monitoring system than the existing system of retrospective 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‐monitoring system that functioned without the direct involvement of transfusion service physicians. This research also evaluated the effectiveness of issuing to physicians a memo with transfusion guidelines. Three process indicators were used to assess physician behavior at various stages of the blood‐ordering process: 1) the number of crossmatches ordered 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 blood utilization: 1) the percentage of patients who received red cell transfusions and 2) the number of blood units transfused per recipient each month. RESULTS: The prospective physician self‐audit system implemented at the study hospital did not reverse physician transfusion decisions, and the process of issuing to physicians a memo with transfusion guidelines at the control hospital failed to reduce blood usage. However, a transient reduction in blood utilization was observed at the study hospital. CONCLUSION: The reduction was hypothesized to be due to a Hawthorne effect, in which observed behavior is affected by the subject's awareness of the research study.