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Prepared by John Grant-Casey Project Manager

National Comparative Audit of the use of blood in Primary, Elective, Unilateral Total Hip Replacement. Prepared by John Grant-Casey Project Manager. East of England RTC. November 2007. The National Comparative Audit Programme. Background information.

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Prepared by John Grant-Casey Project Manager

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  1. National Comparative Audit of the use of blood in Primary, Elective, Unilateral Total Hip Replacement Prepared by John Grant-Casey Project Manager East of England RTC November 2007

  2. The National Comparative Audit Programme Background information • A series of audits designed to look at the use and administration of blood and blood components • Open to all NHS Trusts and Independent hospitals in the UK • Collaborative programme between NHS Blood and Transplant & Royal College of Physicians • Endorsed by the Healthcare Commission

  3. Blood use in Hip Replacements Why was this audit necessary? • Orthopaedic surgery accounts for 10% of red cells used in hospital. • Studies have demonstrated wide variation in practice in the use of red cells • for total hip replacement surgery. • Despite the availability of national guidelines for red cell transfusion, several audits • have shown that a significant amount (10 – 15%) of red cell transfusions could be • avoided in the perioperative period. • In view of the recognized risks of transfusion and the decreasing availability of donor • blood, every effort should be made to minimize inappropriate transfusions. • Health Service Circular 2002/009(BBT2) sets out a programme of action for Chief • Executives of NHS Trusts to avoid unnecessary use of red cells in clinical practice

  4. Blood use in Hip Replacements What were the audit aims & objectives? • The collection of sufficient credible data from a large and representative sample • of hospitals • The production of a report that is widely disseminated to those stakeholders who • have the ability to influence and improve the practice of using blood for this • procedure • The commencement of a dialogue which will lead to meaningful multidisciplinary • discussion on the appropriateness of blood transfusions in patients undergoing • this procedure • A reduction in the inappropriate use of red blood cells in patients undergoing this • procedure

  5. Blood use in Hip Replacements Participation We invited • 183 NHS hospitals • 187 Independent hospitals Who took part • 149 (81%) NHS hospitals sent information • 102 (55%) Independent hospitals sent information Number of patients audited • Nationally = 7465 East of England RTC = 895

  6. Blood use in Hip Replacements Methodology • Methodology – the audit sample • Data collected for 40 consecutive hip replacement operations • All patient ages were eligible

  7. Blood use in Hip Replacements The Audit Results – Key performance indicators 2 key performance indicators were used - % patients transfused and average number of units transfused per patient

  8. Blood use in Hip Replacements The Audit Results – Key performance indicators 2 key performance indicators were used - % patients transfused and average number of units transfused per patient

  9. National Blood use in Hip Replacements Patients having a pre-operative Hb taken

  10. Blood use in Hip Replacements Patients going for surgery with an Hb <12 g/dl

  11. Blood use in Hip Replacements Patients having a post-operative pre-transfusion Hb taken

  12. Blood use in Hip Replacements Transfused patients having a pre-transfusion Hb of <8 g/dl

  13. Blood use in Hip Replacements % Patients possibly over-transfused

  14. Blood use in Hip Replacements Recommendations • In order to minimize the likelihood of a patient receiving a donor blood transfusion, pre-operative anaemia should be corrected as far as possible. • Hospitals should have a written policy for identification and management of anaemia in pre-assessment clinics. • Surgeons seeing patients at initial consultation must ensure that patients have a full blood count, and that anaemic patients are investigated and steps taken to correct the anaemia before surgery. • General Practitioners referring patients for surgery should take measures to optimize the haemoglobin. • Every hospital should have a transfusion policy to guide transfusion in the peri- / post-operative period, based upon one or more of the following: · Symptoms · Haemoglobin concentration · Estimated blood loss • Trusts should ensure that their prescribers are aware that it is not necessary to transfuse patients who are asymptomatic, not bleeding and have a haemoglobin of >8g/dl. • In order to avoid over-transfusion, single-unit transfusions may be appropriate. Hospitals should review the number of units transfused against their patients’ post-transfusion Hb at regular intervals. • Nationally, orthopaedic representation at Hospital Transfusion Committees needs to be improved and more consistent attendance encouraged.

  15. Blood use in Hip Replacements Acknowledgements • Project team: Hari Boralessa, Karen Madgwick, Keith Tucker, Sandy Kidd, Andy Mortimer, John Grant-Casey, and David Dalton • Hospital staff who collected the audit data

  16. National Comparative Audit of the use of blood in Primary, Elective, Unilateral Total Hip Replacement Prepared by John Grant-Casey Project Manager East of England RTC November 2007

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