How appropriately is blood ordered in a rural hospital?

BackgroundBlood products are a limited resource particularly in a rural setting and their appropriate use is important to maintain patient safety and minimise costs.ObjectiveTo assess the appropriateness of transfusion practices in a rural hospital.Design/Data SourcesA retrospective medical record audit of packed red blood cell (PRBC) use.SettingA rural hospital 300 km northwest of Melbourne.ParticipantsAll patients in Wimmera Base Hospital who had a PRBC crossmatch request from October 2010 to March 2011 inclusive.Main outcome measuresProportion of appropriate transfusions and crossmatch to transfusion ratios.ResultsA total of 257 patients and 657 PRBC units were cross-matched during the study period. Of these patients, 28.4% had pre-procedure (elective) cross-matches. Of the elective cross-matches, 27.4% were inappropriate, compared with 16.1% of emergency cross-matches. The cross-match to transfusion ratio (C:T) was 1.59 for emergency requests and 5.96 for elective requests. The C:T ratio was high in the surgical and obstetrics and gynaecology departments. 16.3% of all transfusions were single-unit transfusions.ConclusionsEmergency requests were predominantly appropriate but a significant proportion of elective requests were inappropriate, suggesting changes in elective crossmatch request protocols, and increased education regarding ordering blood in a rural setting.