Assessing transfusion practice in elective surgical patients: a baseline audit

Background Externally generated hospital benchmarking data indicated that the blood transfusion rate within elective surgical orthopaedic and gastrointestinal patients at a metropolitan, tertiary healthcare facility was higher than comparable Australian hospitals. An investigation of transfusion practices was undertaken with the aim of understanding the reasons contributing to this higher incidence. Study Methods A chart audit was undertaken of every major, elective, surgical orthopaedic and gastrointestinal patient who received a blood transfusion between July and December 2017. The audit aimed to ascertain whether patients were screened and treated for preoperative anaemia and measure the clinical appropriateness of transfusions according to the National Blood Authority (NBA) Perioperative Patient Blood Management (PBM) recommendations. The key recommendations include the utilisation of restrictive transfusion thresholds (in conjunction with clinical assessment) and the administration of a single unit followed by clinical reassessment. Results Forty‐five patients had 72 transfusion episodes; 40% of episodes were considered inappropriate (n = 29). Of these, 76% (n = 22) did not have evidence of decompensation, and of the remaining that did (24%, n = 7), there was no evidence of clinical reassessment after transfusion. 42% (n = 19) of patients were anaemic preoperatively, of which only 21% (n = 4) had iron studies, and only one patient received intravenous iron preoperatively. Conclusion Opportunities exist to improve the preoperative anaemia screening processes and clinical decision‐making in transfusion practice. The baseline results of this audit will inform an improvement plan to develop interventions to enhance practice.