A NON-COMPUTER-DEPENDENT PROSPECTIVE REVIEW OF BLOOD AND BLOOD COMPONENT UTILIZATION

The effect that a prospective review of blood and blood component utilization had during a 1-year period at an 850-bed tertiary-care teaching hospital is reported. The review process, which has been in operation for 18 years, is based on institutionally developed usage guidelines for blood, fresh-frozen plasma (FFP), platelets (Plts), and cryoprecipitate (Cryo). The guidelines were developed by the hospital's Transfusion Medicine Committee. The review is initiated by the transfusion service technical personnel when an order is received. Back-up support is provided, as needed, by physicians on the service or by those pathology residents taking off-hour call. They consult with the ordering physician when questions arise as to the appropriateness of an order as it relates to the patient's clinical situation. Screening values used in the initial evaluation of each order are: hematocrit, less-than-or-equal-to 27 percent (0.27) for blood; prothrombin time, greater-than-or-equal-to 16 seconds, and/or activated partial thromboplastin time, greater-than-or-equal-to 60 seconds, for FFP; bleeding time, greater-than-or-equal-to 16 minutes and/or a platelet count of 20 to 100 x 10(3) per mm3 (20-100 x 10(9)/L), as related to clinical conditions, for Plts; and fibrinogen less-than-or-equal-to 120 mg per dL (1.2 g/L) for Cryo. Also taken into consideration is the stated clinical indication, which is provided when the requisition is submitted. As a result of the prospective review, orders for blood and/or components for 114 patients were canceled, and 51 patients received 207 blood components that were more appropriate for the clinical situation. A total of 316 homologous donor exposures were avoided during the year surveyed. A total reduction in patient medical costs of $22,000 was realized as a result of canceled orders, a decrease in the number of units transfused, or the selection of a more appropriate component for transfusion.