Prospective platelet auditing: Resident compliance and the cost of training

Apheresis platelets are a product with high cost and limited supply commonly used for hematopoietic transplant patients. There is potential for both transfusion reactions and refractoriness associated with this product. Therefore, transfusion guideline compliance is closely monitored. This is a quality assurance review of a prospective platelet audit covering an 18-month period. Audit records created by trainees in their first post graduate year (PGY1) were compared to subsequent years. Multivariate regression analysis considered the variables of patient age, sex, PGY level, and platelet count. Financial modeling was derived for best case (low cost), base case (average cost), and worst case (high cost) scenarios. There were 1931 platelet doses requiring approval with 1122 (58%) compliant with hospital transfusion policy and 809 (42%) not compliant. Products ordered but not compliant with hospital policy were appropriately held from release by PGY1 physicians for 186/428 (43%) doses and 279/381 (73%) doses by PGY > 1 physicians (P < .01). Multivariate analysis demonstrated significance only in the categories of PGY level and platelet count. The ordered doses not compliant with hospital policy had an estimated minimal cost of $404 500. There were a disproportionately higher number of platelets released by the PGY1 group. Potential mitigation strategies for this include a closer level of oversight or hiring a patient blood manager to provide real-time metrics. Prevention of unnecessary transfusions is important in hematopoietic transplant patients both to prevent infections and decrease foreign antigen exposure and transfusion refractoriness.