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Patient factors associated with duration of certified sickness absence and transition to long-term incapacity.

BACKGROUND: Despite a considerable increase in claims for long-term sickness benefits, and the impact of certifying sickness upon general practitioner (GP) workload, little is known about transition to long-term incapacity for work. AIM: To explore the relationship between patient factors and the transition from short-term to long-term work incapacity, in particular focusing on mild mental health and musculoskeletal problems. SETTING: Nine practices comprising the Mersey Primary Care R&D Consortium. DESIGN: Prospective data collection and audit of sickness certificate details. METHOD: GPs issued carbonised sickness certificates for a period of 12 months. The resulting baseline dataset included claimant diagnosis, age, sex, postcode-derived deprivation score, and sickness episode duration. Associations of patient factors with sickness duration outcomes were tested. RESULTS: Mild mental disorder accounted for nearly 40% of certified sickness. Relatively few claimants had their diagnosis changed during a sickness episode. Risk factors for longer-term incapacity included increasing age, social deprivation, mild and severe mental disorder, neoplasm, and congenital illness. For mild mental disorder claimants, age, addiction, and deprivation were risk factors for relatively longer incapacity. For musculoskeletal problems, the development of chronic incapacity was significantly related to the nature of the problem. Back pain claimants were likely to return to work sooner than those with other musculoskeletal problems. CONCLUSIONS: In addition to the presenting diagnosis, a range of factors is associated with the development of chronic incapacity for work, including age and social deprivation. GPs should consider these when negotiating sickness certification with patients.

Acute Disease↗

The relationship between children's dental caries experience and the prescription of general anaesthetics. an evaluation of the effectiveness of a Personal Dental Service Pilot.

OBJECTIVES: To determine if there was a high correlation between the prescription of a general anaesthetic for dental treatment in young children by a Personal Dental Services (PDS) general anaesthetic pilot and the dental health of children at a ward level. BASIC RESEARCH DESIGN: Postcode data from an audit of the single dental general anaesthetic provider in an area was extracted and mapped to individual wards. A proxy for the oral health population was obtained by using the results of a large-scale dental prevalence study of five-year-olds. The wards were ranked into quintiles by dmft and a mean dmft calculated for each. There were 1,406 patients who had a general anaesthetic, 74% were aged 11 years or less. SETTING: A personal dental service dental general anaesthetic pilot in the north of England providing services for a population of approximately 300,000 residents in a non-fluoridated area. RESULTS There was a positive correlation between increasing levels of dental decay in the population and increasing intervention ratios for dental treatment under general anaesthesia (r2 = 0.90). CONCLUSIONS: The PDS pilot provided dental care under general anaesthesia for more patients from wards with poor dental health than from wards with better dental health.

Anesthesia, Dental↗

The surgical value of community hospitals: a closer look.

To assess and compare the safety and efficiency of a surgical unit at a District General Hospital and a Community Hospital for elective cold surgery. A retrospective survey was made using regional computer Hospital Activity Analysis data and monthly audit meeting records of all inpatients having selected elective general surgical operations on one consultant's firm over a period of one year, at Torbay Hospital, Torquay, (DGH) and Newton Abbot Hospital, Newton Abbot (CH). All inpatients and day cases admitted under CACC from April 1, 1987, until March 31, 1988, were studied comparing mortality, morbidity and efficiency for comparable elective surgical procedures. A postal questionnaire to assess patient satisfaction with surgical care at both hospitals was included in the study. 350 patients underwent elective surgical procedures at the DGH and 380 patients underwent similar procedures at the CH. There was no significant increase in mortality and morbidity at the CH, which was preferred by most patients for routine surgical operations. The Community Hospital unit was found to be satisfactory and more efficient for routine elective surgery as determined from the above parameters and the patients themselves.

Consumer Behavior↗

Squamous cell carcinoma of the penis.

Squamous cell carcinoma of the penis (CA Penis) is not a rare disease in P.R. We have reviewed all cases of CA penis diagnosed in our institution from Jan. 79-Jan. 89. Pathology and hospital records were audited. The survival data on all patients was updated via telephone or record review up to May 89. A total of 18 pts were seen in the last decade. Of these 11. (61%) were seen in the last four years. Four of 18 patients were excluded from analysis due to lack of staging and therapy data. The median age 54.9 y (range 23-82y). The following risk factors were identified: phimosis 12/14 (86%) p = .05, leukoplakia 8/14 (57%); prior venereal disease 1/14 (7%). The primary lesion appeared in the prepuce 8/14 (57%) and glans 6/14 (43%). TNM staging was done in all pts. Most pts presented with T3 or T4 disease 10/14 (71%) and palpable regional adenopathy (N1-N3) 9/14 (64%). Of the nine pts with palpable adenopathy, in 5 (56%) microscopic malignant disease was confirmed. A correlation between T3 or T4 disease and the presence of palpable adenopathy was seen (80%). The Stage at diagnosis of the 14 pts: I: 0/14 (29%), II: 5/14 (7%), III: 3/14 (21%), IV: 6/14; (43%). All pts were treated with partial penectomy and 7/14 had unilateral or bilateral inguinal lymphadenectomy. Long term survivors (LTS), greater than 12 mo., were seen 3/4 pts with Stage II disease, 1/3 Stage III, and 2/5 in Stage IV. The most important prognostic factor for LTS was malignant involvement of regional lymph nodes with 0/5 in this group.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗

A district general hospital experience of surgical treatment of gastric and duodenal ulcer from 1970 to 1982.

Seven hundred and thirteen patients who had undergone 793 operations for peptic ulcer disease during the years 1970 to 1982 were subsequently referred to a gastric follow-up clinic. The indications for initial elective surgical treatment (514) were failed medical management (448), recent hemorrhage (32) and obstruction of gastric outflow (34); for initial emergency surgical treatment (199), the indications were hemorrhage (97) and perforation (102). Reoperation was required in 80 patients-previous perforation (40), recurrent ulcer (32), reperforation (three), hemorrhage (three) and obstruction of gastric outflow (two). The over-all postoperative mortality rate was 4.2 per cent (33 of 713); 15 deaths occurred after elective surgical treatment (2.5 per cent) and 18 after emergency surgical treatment (8.6 per cent). The postoperative morbidity expressed in terms of duration of postoperative stay was unaltered for each procedure throughout the study period. Follow-up attendance rates at one, three, five and ten years were 86, 85, 74 and 28 per cent, respectively. Iron deficiency anemia was detected in 13.6 per cent of gastric resection procedures and 1.6 per cent of vagotomy and drainage procedures. No instances of macrocytic anemia and only two instances of asymptomatic metabolic bone disease were recorded. By providing accurate data for surgical audit, which suggested that screening for metabolic sequelae in the first decade after surgical treatment is not indicated and which resulted in alteration of policy toward peptic ulcer perforation, a specific follow-up clinic has proved valuable in formulating the over-all management policy regarding surgical treatment for peptic ulcer.

Adult↗

Uncompensated hospital care payment and access for the uninsured: evidence from New Jersey.

OBJECTIVE: We assess the impacts of New Jersey's payment for hospital uncompensated care on access for the uninsured. DATA SOURCES: Uncompensated care charges and other data were obtained from audited reports maintained by the New Jersey State Department of Health. Other data sources include the AHA Annual Survey and the Bureau of Labor Statistics. The sample includes 80 of 88 acute care hospitals in the state for 1979 to 1987. STUDY DESIGN: This study used a pre- and postdesign to assess the impacts of the introduction of uncompensated care payment. Both descriptive and multivariate analyses were used. Key variables include hospital ownership and teaching characteristics; the labor force composition; and the level of government funding for public health insurance. PRINCIPAL FINDINGS: The overall level of uncompensated hospital care increased markedly in New Jersey during the period 1979 through 1987. However, this trend can be attributed to variables other than the new payment system, including increased demand for uncompensated care. The program did result in a more even distribution of uncompensated care across hospitals. The financial condition of hospitals providing the largest share of this care also improved, ensuring continued access. CONCLUSIONS: Funding of uncompensated care via hospital payment regulation did not increase its overall provision. However, improved access was achieved as opportunities for the uninsured to receive care were made more widely available.

Financial Management, Hospital↗

[Value of dexamethasone in purulent meningitis in children. Apropos of a comparative study of 85 children].

BACKGROUND: The beneficial effect of dexamethasone plus antibiotic therapy in bacterial meningitis is still controversial. PATIENTS AND METHODS: Eighty-five children, aged 1 month to 14 years, were admitted between 1987 and 1990 for bacterial meningitis. They received the same antibiotic therapy for 10 days (7 days in meningococcal meningitis). The 44 children admitted since March 1989 were also given dexamethasone (0.15 mg/kg/6 hours for 4 days); the first injection was given before antibiotic therapy. Clinical (fever, neurological findings, audition) and laboratory data [CSF proteins, glucose, lactate, cell and bacterial counts; blood C-reactive protein (CRP), hemoglobin, leukocytes and platelets] were analyzed statistically. RESULTS: The group treated with antibiotics plus dexamethasone showed decreases significantly greater in CSF protein and lactate levels after 48 hours than the children given antibiotics alone and an early (6 hours after the start of treatment) increase in CSF glucose. The blood CRP level of the dexamethasone plus antibiotics group decreased significantly within 48 hours. The numbers of neurological sequelae and deaths in this group were clearly lower than for the antibiotic group, but the risk of deafness did not appear to be altered. CONCLUSIONS: These results confirm the beneficial effect of dexamethasone reported earlier. The relatively frequent transient recurrences of fever and increased CRP when dexamethasone was interrupted suggest that the dose and/or duration of dexamethasone treatment should be modified.

Adolescent↗

Optometrist screening for diabetic retinopathy: evidence and environment.

A recent English government-funded study has suggested that optometrists are not best suited to screening for diabetic retinopathy. This is surprising given the level of training of optometrists and their aptitude in detecting other conditions such as glaucoma and cataract. The need to screen for diabetic retinopathy is discussed. The major unresolved issue concerns the choice of screening modality, i.e. who should perform screening, when and how. A literature search is reported. Given the available evidence, to make conclusions about the relative performance of optometrists with other screeners would be inappropriate. Unresolved controversies could be addressed by new prospective studies of optometrists, and others, in screening. A pragmatic design, mirroring the current environment of care, may be important. In particular, the manner in which diabetics currently present to the health service would make screening by one modality of limited use. If thoughtfully applied, shared care concepts may achieve a broader coverage of patients with diabetics mellitus. Smaller trials investigating sub-issues, and surveys of patients and potential screeners may produce a valuable backdrop in designing appropriate studies. Issues for the development of screening schemes are considered, including the role of training, the development of protocols for care and sharing data, reimbursement and audit.

Cost-Benefit Analysis↗

Conduct of an internal review as part of the Application Integrity Policy.

This article reflects the authors' experiences in the conduct of a third-party internal review of a device manufacturer as part of the Application Integrity Policy. The experiences are discussed in terms of recommended operational procedural issues from the vantage point of the sponsor and consultant(s). Issues pertaining to the sponsor, such as employee cooperation, work priorities and responsibilities, the assembly of data to be audited, and the need to have an orientation program for the consultant(s), will be discussed. Likewise, issues pertaining to the consultant(s), such as their expertise, the need for a clearly defined audit plan and work assignments, the handling of interpersonal conflicts if they arise, and the content of the audit report, will be discussed.

Consultants↗

Final report from the ASERNIP-S audit of laparoscopic live-donor nephrectomy.

The Australian Safety and Efficacy Register of New Interventional Procedures--Surgical (ASERNIP-S) audit of laparoscopic live-donor nephrectomy commenced in 1999 and concluded in 2003. Six centres in Australia and New Zealand contributed data for 219 donor patients regarding perioperative and postoperative outcome of surgery and short-term follow-up. These data were compared with a recent systematic review of LLDN. The Australasian experience to date compared favourably with worldwide practice, both in terms of efficacy and safety for donors (at least in the short term). The collection of audit data, as this technique was introduced into the Australasian healthcare system, has allowed the local experience with this technique to be pooled and shared, resulting in the development of Australasian practice in line with world's best practice in this area.

Adult↗

Does participation in distance learning and audit improve the care of patients with acute asthma attacks? The General Practitioners in Asthma Group.

OBJECTIVE: To test whether general practitioners who completed an audit cycle encompassing a data recording exercise, distance learning programme and personalized feedback changed their management of patients with acute asthma attacks. DESIGN, SETTING AND SUBJECTS: Practice and patient details from two national correspondence surveys of the management of acute asthma attacks in the United Kingdom in 1991-92 and 1992-93 were compared. Main outcome measures were use of nebulised bronchodilators, systemic steroids during an asthma attack, and increased use of prophylactic therapy after attacks. RESULTS: Ninety-one general practitioners completed an audit cycle and reported data on 782 patients with asthma attacks in 1991-92 and 669 in 1992-93. There were no significant changes in practice resources during this time. Management changed in line with recommended guidelines and audit feedback suggestions leading to more use of nebulised bronchodilators [272 (35%) before, 268 (40%) after, Odds Ratio (OR) 0.80, 95% Confidence Intervals (CI) 0.64-0.99], systemic steroids [563 (72%) before, 506 (76%) after, OR 0.83, CI 0.65-1.06], and 'step-up' in preventative therapy [402 (51%) before, 382 (57%) after, OR 0.79, CI 0.64-0.98]. CONCLUSION: General Practitioners who completed an audit cycle showed changes in the management of acute asthma attacks in line with guidelines which may have been caused by participation in distance learning and clinical audit. However, general practitioners motivated to change clinical management may be similarly motivated to take part in audit. Audit may be the catalyst for change rather than the cause of change.

Acute Disease↗

Towards effective obstetric anaesthetic audit in the UK.

Obstetric audit is multidisciplinary, but maternal mortality data represent the only national obstetric anaesthetic audit currently available in the UK. Maternity and neonatal audit is progressing towards the collection of both numerator and denominator data in order to compare local, regional and national figures. Obstetric anaesthetists as a professional group play a significant role in maternity care and have in the past developed a minimum data set. Such a set now requires revision of items, agreement on definitions and integration with national projects. Since local and regional obstetric anaesthesia data collection systems are available, albeit in various manual or computerized forms, this is an achievable target. A standard maternity and neonatal data set which incorporates obstetric anaesthetic clinical items could offer a qualitative comparison of process variables and outcome, but should be under professional anaesthetic control. In addition, the process may enable professional standards to be defined and tested so that high quality obstetric anaesthetic care can be maintained.

Journal Article↗

A comparative analysis of six audit systems for mental health nursing.

PURPOSE: To devise an analytical framework to help identify strengths and weaknesses in the audit process as specified by existing psychiatric nursing audit systems, in order to analyse current audit practice and identify improvements for incorporation in the Newcastle Clinical Audit Toolkit for Mental Health. DATA SOURCES: Published material relating to the following six systems: the Central Nottinghamshire Psychiatric Nursing Audit; Psychiatric Nursing Monitor; Standards of Care and Practice; Achievable Standards of Care; Quartz; and Quest. DATA EXTRACTION: Comparison of the six systems according to an analytical framework derived from detailed empirical study (structures, processes and outcomes) of one of them in use and the educational evaluation literature. Examination of the extent to which guidance is provided for operating the systems and for wider process-related aspects of audit. RESULTS OF DATA SYNTHESIS: Five of the systems failed to specify some important elements of the audit process. Conceptually, the six systems can be divided into two main types: 'instrument-like' systems designed along psychometric lines and which emphasize the distance between the subjects of audit and the operators of the systems, and 'tool-like' systems which exploit opportunities for care setting staff to engage in the audit process. A third type of system is the locally-developed system which is offered to a wider audience but which does not make the same level of claim to universal applicability. CONCLUSION: The analytical framework allows different approaches to audit to be compared and contrasted not only according to the techniques used, but also according to process issues. The analysis of six systems revealed a variety of different techniques and procedures which can facilitate, in a methodologically rigorous manner, practitioner and other stakeholder involvement in audit processes.

Humans↗

NTP Toxicology and Carcinogenesis Studies of Tris(2-ethylhexyl)phosphate (CAS No. 78-42-2) In F344/N Rats and B6C3F1 Mice (Gavage Studies).

Tris(2-ethylhexyl)phosphate is one of a family of triakyl phosphates that have been widely used as fire retardants and plasticizers. Another triakyl phosphate, tris(2,3-dibromopropyl)phosphate (Tris-BP), once used as a flame retardant in children's sleepwear, has been shown to be carcinogenic, but tris(2-ethylhexyl)phosphate has not been previously studied. Tris(2-ethylhexyl)phosphate, a clear, viscous liquid, is used as a component of vinyl stabilizers, grease additives, and flame-proofing compositions; however, it is used primarily as a plasticizer for vinyl plastic and synthetic rubber compounds. In 1974, approximately 3 million pounds of tris(2-ethylhexyl)phosphate was produced in the United States; imports during that year were negligible. Substantial human exposure probably occurs during production of tris(2-ethylhexyl)phosphate and during the manufacture and use of products containing it, but data on the magnitude of exposure are not available. Two-year toxicology and carcinogenesis studies of tris(2-ethylhexyl)phosphate were conducted by administering the test chemical in corn oil by gavage, 5 days per week for 103 weeks, to groups of 50 male and 50 female F344/N rats and B6C3F1 mice. Male rats received doses of 2,000 or 4,000 mg/kg body weight, female rats received 1,000 or 2,000 mg/kg, and male and female mice received 500 or 1,000 mg/kg. Fifty vehicle control animals of each sex and species received 10 ml/kg body weight (rats) or 3.3 ml/kg (mice) corn oil by gavage on the same schedule. Inflammation of the gastric mucosa in mice and mild weight depression in rats and mice were the only dose-related effects observed in the preliminary studies. In the 2-year studies, survival rates and mean body weight gains of dosed female rats and dosed mice were comparable to those of their perspective controls. Survival rates of dosed male rats were comparable to that of the vehicle controls, but body weight gains were depressed. One nonneoplastic lesion, follicular cell hyperplasia of the thyroid, was observed at increased incidences in dosed male and female mice. Two compound-related increased incidences of neoplasms could not be discounted. In male rats, the incidence of pheochromocytoma of adrenal glands increased with dose (2/50, 4%; 9/50, 18%; 12/50, 24%). There were also two additional malignant pheochromocytomas in the high dose group. However, the incidence of adrenal pheochromocytoma in vehicle controls of this study (2/50, 4%) was low compared with the 25% incidence observed in two previous studies in this laboratory or the overall historical incidence of 18% observed throughout the Program, and thus the evidence of carcinogenicity was considered to be equivocal. In female mice, the incidence of hepatocellular carcinoma (0/48; 4/50; 7/50) in high dose animals (1,000 mg/kg) was significantly increased relative to that of the vehicle controls. Decreased incidences were observed for acinar cell adenomas of the pancreas in dosed male rats (14/50, 28%; 5/48, 10%; 2/49, 4%) and for fibroadenomas of the mammary glands in low dose female rats (11/50, 22%; 2/50, 4%; 7/50, 14%). Hemangiosarcomas of the circulatory system in male mice (7/50, 14%; 0/50; 1/49, 2%) and lymphomas of the hematopoietic system in female mice (14/49, 29%; 10/50, 20%; 6/50, 12%) were decreased compared with vehicle controls. A decrease in the incidence of lymphomas and an increased incidence of carcinomas of the liver in female mice (both seen in this study) were observed in studies of di(2-ethylhexyl)adipate. Increased incidences of liver carcinomas and decreased incidences of mammary fibroadenomas were observed also in female rats in the di(2-ethylhexyl)phthalate studies. A possible link among these three chemicals may be metabolic conversion to 2-ethylhexanol. Tris(2-ethylhexyl)phosphate was not mutagenic in Salmonella typhimurium strains TA98, TA100, TA1535, or TA1537 in the presence or absence of 9000 x g (S9) fractions from Aroclor 1254-induced Sprague-Dawley rat or Syrian hamster liver. An audit of the experimental data from these carcinogeneoclor 1254-induced Sprague-Dawley rat or Syrian hamster liver. An audit of the experimental data from these carcinogenesis studies was conducted by the National Toxicology Program. No data discrepancies were found that significantly influenced the final interpretations of these experiments. Under the conditions of these studies, a comparison of concurrent and historical controls indicated that there was equivocal evidence of carcinogenicity in male F344/N rats receiving 2,000 and 4,000 mg/kg tris(2-ethylhexyl)phosphate, as evidenced by increased incidences of pheochromocytomas of the adrenal glands. There was no evidence of carcinogenicity in female F344/N rats or in male B6C3F1 mice receiving tris(2-ethylhexyl)phosphate. There was some evidence of carcinogenicity in female B6C3F1 mice that received 1,000 mg/kg tris(2-ethylhexyl)phosphate, as shown by an increased incidence of hepatocellular carcinoma. Tris(2-ethylhexyl)phosphate was associated with increased incidences of follicular cell hyperplasia of the thyroid gland in male and female B6C3F1 mice. Synonyms and Trade Names: TOF; trioctyl phosphate; phosphoric acid tri(2-ethylhexyl) ester; Flexolreg. TOF; Kronitexreg.

Journal Article↗

Quality and completeness of histopathology reports of rectal cancer resections. Results of an audit in Brittany.

UNLABELLED: Few data are available in France about implementation of guidelines for pathology reports of rectal cancer resections. AIM: The purpose of this study was to audit quality and completeness of histopathology reports of rectal cancer resections in Brittany by comparing results with French guidelines published in 1998. METHODS: All inhabitants in Brittany who were beneficiaries of the general health insurance system and who underwent surgery for rectal cancer between February 1999 and January 2000 were included in the study. Twenty-one pathology laboratories, including 14 private laboratories, participated in this study. All pathology reports were examined by two physician-consultants of the health insurance system trained in the analysis of pathology reports (search for consigned or missing data). Results were compared with guidelines published in 1998. RESULTS: Of 234 pathology reports, 204 (84%) mentioned the number of examined lymph nodes and 217 (93%) the number of those found positive. The criterion of at least 8 examined lymph nodes was noted in 53.4% of reports. Longitudinal margin involvement was recorded in 92% of reports and circumferential margin involvement in 27% only. Venous and/or lymphatic and neural invasion were recorded in 34% and 18% of reports, respectively. Tumor staging was made by using UICC (pTNM) in 67% of reports. CONCLUSION: This study shows that the quality and completeness of histopathology reports of rectal cancer resections could be improved in Brittany. Despite its documented value as an important predictor of local recurrence, circumferential margin involvement is too frequently omitted. Standardisation of the examination procedures and exhaustive reporting would be useful to improve practice quality.

Aged↗

A five year study of high falls in Edinburgh.

High falls are a common cause of death and disability. The aim of this study was to obtain an epidemiologically complete picture of all high falls over a 5 year period in Edinburgh, Scotland. Prospectively collected data on hospital survivors and hospital deaths was collected from the Scottish Trauma Audit Group (STAG) database. Data on prehospital deaths was obtained from autopsy reports and detailed police enquiry reports. There were 341 patients in the study, of whom 82% were male. Seventy-four percent survived to hospital discharge. Sixty-three percent of the total deaths appeared to be suicides. Head and chest injuries were responsible for the majority of deaths. Pelvis, limb and vertebral injuries predominated in survivors. In conclusion, prevention may be the most effective method of reducing prehospital deaths. Abdominal injuries were associated with a poor outcome, but survival might improve with immediate surgical exploration in haemodynamically unstable patients.

Accidental Falls↗

The utility of an automated electronic system to monitor and audit transfusion practice.

BACKGROUND AND OBJECTIVES: Transfusion laboratories with transfusion committees have a responsibility to monitor transfusion practice and generate improvements in clinical decision-making and red cell usage. However, this can be problematic and expensive because data cannot be readily extracted from most laboratory information systems. To overcome this problem, we developed and introduced a system to electronically extract and collate extensive amounts of data from two laboratory information systems and to link it with ICD10 clinical codes in a new database using standard information technology. MATERIALS AND METHODS: Three data files were generated from two laboratory information systems, ULTRA (version 3.2) and TM, using standard information technology scripts. These were patient pre- and post-transfusion haemoglobin, blood group and antibody screen, and cross match and transfusion data. These data together with ICD10 codes for surgical cases were imported into an MS ACCESS database and linked by means of a unique laboratory number. Queries were then run to extract the relevant information and processed in Microsoft Excel for graphical presentation. We assessed the utility of this data extraction system to audit transfusion practice in a 600-bed adult tertiary hospital over an 18-month period. RESULTS: A total of 52 MB of data were extracted from the two laboratory information systems for the 18-month period and together with 2.0 MB theatre ICD10 data enabled case-specific transfusion information to be generated. The audit evaluated 15,992 blood group and antibody screens, 25,344 cross-matched red cell units and 15,455 transfused red cell units. Data evaluated included cross-matched to transfusion ratios and pre- and post-transfusion haemoglobin levels for a range of clinical diagnoses. Data showed significant differences between clinical units and by ICD10 code. CONCLUSION: This method to electronically extract large amounts of data and linkage with clinical databases has provided a powerful and sustainable tool for monitoring transfusion practice. It has been successfully used to identify areas requiring education, training and clinical guidance and allows for comparison with national haemoglobin-based transfusion guidelines.

Adult↗