INFLUENCE OF CLINICAL KNOWLEDGE, ORGANIZATIONAL CONTEXT, AND PRACTICE STYLE ON TRANSFUSION DECISION-MAKING - IMPLICATIONS FOR PRACTICE CHANGE STRATEGIES
INFLUENCE OF CLINICAL KNOWLEDGE, ORGANIZATIONAL CONTEXT, AND PRACTICE STYLE ON TRANSFUSION DECISION-MAKING - IMPLICATIONS FOR PRACTICE CHANGE STRATEGIES
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DOI：
10.1001/jama.264.4.476
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发表时间：
1990-07-25
影响因子：
120.7
通讯作者：
SOUMERAI, SB
中科院分区：
文献类型：
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作者：
SALEMSCHATZ, SR;AVORN, J;SOUMERAI, SB
有证据表明，血液制品与其他医疗保健资源一样，经常被不当使用，但其原因尚未得到充分研究。我们对三所医院的 122 名普通外科医生、骨科医生和麻醉科医生进行了面对面调查，以评估多种临床和非临床因素对输血决策的影响。我们发现医生对输血风险和适应症的了解普遍存在缺陷。不到一半的受访医生正确估计了每种输血风险，并且只有 31% 的医生正确回答了有关输血指征的四个问题。主治医生的知识得分通常低于住院医师，但他们对自己的知识表现出更强的信心。然而，住院医生的输血决定很大程度上受到主治医生意愿的影响，导致他们可能下达不适当的输血命令。在接受调查的居民中，61% 的人表示，他们每月至少要求进行一次他们认为不必要的输血，因为一位更资深的医生建议他们这样做。这些发现为制定改善输血实践的策略提供了见解，这将解决护理质量和成本控制的双重问题。
Evidence shows that blood products, like other health care resources, are often used inappropriately, but the reasons for this have not been well studied. We conducted a face-to-face survey of 122 general surgeons, orthopedic surgeons, and anesthesiologists in three hospitals to evaluate the influence of several clinical and nonclinical factors on transfusion decision making. We found widespread deficiencies in physicians'' knowledge of transfusion risks and indications. Each transfusion risk was estimated correctly by fewer than half of the physicians surveyed, and only 31% responded correctly to a set of four questions regarding transfusion indications. Attending physicians routinely had lower knowledge scores than did residents, yet they exhibited more confidence in their knowledge. Residents'' transfusion decisions, however, were strongly influenced by the desires of their attending physicians, resulting in their ordering potentially inappropriate transfusions. Of the residents surveyed, 61% indicated that they ordered transfusions that they judged unnecessary at least once a month because a more senior physician suggested that they do so. These findings provide insights for the development of strategies to improve transfusion practices, which would address the dual concerns of quality of care and cost containment.