Risk factors and transfusion requirements in aortic surgery.

An audit of heterologous blood usage was made on 169 of 185 successive patients undergoing aortic surgery with a view to identifying factors determining individual transfusion requirements. The use of knitted prostheses was associated with 1.4 units, and aneurysmal disease 1.0 units of extra transfusion. Other factors influencing extra transfusion requirements were presence of hypertension, diabetes mellitus and low preoperative haemoglobin values. Clearly, if appropriate, the use of woven grafts seems worthwhile in terms of reduced transfusion requirements. However, individual prediction of patient transfusion requirements does not appear feasible with the factors studied.

Getting a validated guideline into local practice: implementation and audit of the SIGN guideline on the prevention of deep vein thrombosis in a district general hospital.

This paper describes the implementation of a specific clinical guideline on venous thromboprophylaxis and outlines the audit design and methods used to achieve this objective. A member of the clinical staff was seconded to oversee this implementation and co-ordinate audit of current in the main clinical specialties within the trust. The Trust Clinical Audit Committee agreed to fund this low cost initiative (approximately 3,800 pounds) from clinical guideline monies. Findings from the initial audit revealed a total of 224 patients identified as 'at risk' of developing deep vein thrombosis or pulmonary embolism. Of this number 72.8%, (n = 163), were prescribed prophylaxis compared with the pre-set standard of 90.0%. Fifty four percent, (n = 122), of all identified patients were prescribed the correct prophylaxis in accordance with SIGN guideline recommendations. As a result of the initial findings local prevention protocols were developed or upgraded as required in line with the national guideline. The repeat audit findings highlighted a significant increase in the number of 'at risk' patients prescribed prophylaxis rising from 72.8% to 97.4% (P < 0.001) and similarly from 54.5% to 95.9% for those prescribed the correct prophylaxis (P < 0.001).