Algorithms for evaluating the appropriateness of blood transfusion.

Medicare regulations and the guidelines of the Joint Commission on Accreditation of Healthcare Organizations require assessment of the appropriateness of transfusions by a hospital committee. A set of criteria maps for component transfusion review by nurses or technical personnel was designed, tested, and modified. The algorithms were based on written guidelines developed by a group of physicians. In the first part of the study, 196 medical records of patients from medical and surgical diagnosis-related groups with the highest utilization of blood (Group I) were screened. Forty patients were excluded because of a preexisting transfusion protocol. Of the remaining 156 patients, 146 (94%) received red cell transfusions, of which 96 percent were indicated, 1 percent not indicated, and 3 percent controversial. Thirty-five patients (22%) received fresh-frozen plasma transfusions, of which 69 percent were indicated, 11 percent not indicated, 17 percent controversial, and 6 percent indeterminate. In the second part of the study, medical records were screened from 99 randomly selected patients who had received red cell transfusions (Group II), and the results were similar to those in Group I. Physician review was necessary in 20 percent of the transfused patients screened with the criteria maps. It is concluded that algorithms for transfusion review can be developed and used easily to fulfill regulatory and accreditation requirements and to plan focused educational programs.