Audet A M, Goodnough L T, Parvin C A
MassPRO, Waltham, MA 02154, USA.
Int J Qual Health Care. 1996 Feb;8(1):41-9. doi: 10.1093/intqhc/8.1.41.
Several studies have looked at the appropriateness of red blood cell transfusions, using retrospective chart reviews to assess compliance with guidelines. The goal of this study was to determine the quality of medical chart documentation, and assess the validity and the feasibility of using retrospective chart review data as part of a quality improvement (QI) program, to evaluate the appropriateness of peri-operative transfusions.
The charts of 188 patients admitted for elective orthopedic surgery were reviewed. Both intra-operative and post-operative transfusion events (n = 353) were analyzed.
Only 68% of post-operative transfusion events on the day of surgery and 35% of transfusion events on days after surgery were accompanied by documentation of blood loss and/or change in vital signs. Symptoms were recorded in only 10% of post-operative transfusion events. The rationale for transfusion was recorded in only 16% of post-operative transfusion events on the day of surgery, in 27% on post-operative days and in 95% of intra-operative transfusions. The documentation of rationale was not different for transfusion events involving autologous blood (31%) or allogeneic blood (32%). This study provided information on transfusion practices. Single unit transfusions occurred in only 47 and 34% of patients receiving autologous and allogeneic blood, respectively. Only 19% of patients transfused with more than one allogeneic blood units, were clinically reassessed between blood units, compared to 34% of patients receiving more than one autologous blood unit. We conclude that retrospective chart reviews are limited by inadequate documentation and may not be the optimal source of information to determine the appropriateness of a transfusion. Improved methods (e.g. prospective reviews, or other system-level data collection methods) are needed for QI programs to influence practice. Despite its limitations, the information obtained suggests that current practice could be improved.
多项研究通过回顾性病历审查来评估红细胞输血的适宜性，以判断是否符合指南要求。本研究的目的是确定病历记录的质量，并评估将回顾性病历审查数据用作质量改进（QI）计划的一部分以评估围手术期输血适宜性的有效性和可行性。
对188例择期骨科手术患者的病历进行审查。分析了术中及术后的输血事件（n = 353）。
手术当天术后输血事件中仅有68%以及术后其他日子输血事件中仅有35%伴有失血和/或生命体征变化的记录。术后输血事件中仅有10%记录了症状。输血理由在手术当天的术后输血事件中仅16%有记录，术后其他日子为27%，术中输血为95%。涉及自体血（31%）或异体血（32%）的输血事件，其理由记录情况无差异。本研究提供了输血实践的相关信息。接受自体血和异体血的患者中，分别仅有47%和34%接受了单单位输血。接受多个异体血单位输血的患者中，仅有19%在输血单位之间进行了临床重新评估，而接受多个自体血单位输血的患者这一比例为34%。我们得出结论，回顾性病历审查受记录不充分的限制，可能并非确定输血适宜性的最佳信息来源。质量改进计划需要改进方法（如前瞻性审查或其他系统层面的数据收集方法）来影响实践。尽管存在局限性，但所获得的信息表明当前实践仍可改进。
