Toward meaningful blood usage review: comprehensive monitoring of physician practice.

During a one-year period, all blood transfusions at an acute care Veterans Administration hospital were concurrently reviewed. Inappropriate transfusion episodes represented less than 2% of the total according to clinical criteria established for purposes of screening cases. The percentage of episodes reviewed that did not meet the screening criteria decreased progressively (3.6% to 0.3%) during the study period. Episodes in which red blood cells (RBC) or fresh frozen plasma (FFP) alone and RBC and FFP together were transfused comprised almost all of the cases that were unjustified by peer review. The findings indicated that, although comprehensive review may document the overall appropriateness of clinical transfusion practice, more detailed profiling of clinical circumstances of each episode is necessary to provide convincing arguments for major revisions in hemotherapy practice.