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Blood management remains challenging.First, there are limitations to the blood supply.In the United States, only 5% of eligible volunteer donors give blood while the U.S.Food and Drug Administration has imposed increasing restrictions on donor eligibility based upon emerging threats to the blood supply safety (for example, deferral for travel to United Kingdom and Western Europe due to variant Creutzfeldt-Jakob disease risk).Equally important are inappropriate transfusions resulting in excessive utilization due to variable and indiscriminate physician transfusion practices.Contributing reasons for indiscriminate transfusion practices are multifactorial, of which we have studied several within our hospital.One reason is that physician transfusion medicine knowledge is generally poor.In a study,including data from our hospital, overall score of physicians in various specialties and training levels on a basic transfusionmedicine knowledge assessment survey was only 31%.Furthermore, data from a transfusion consent study within our hospital showed physicians overstated benefits (citing false benefits such as wound healing) while understating risks (few cited transfusion-related acute lung injury, the leading cause of transfusion fatality).Thus, transfusion medicine education is a priority to improve transfusion practices.Another reason is poor transfusion documentation.In a study of 172 transfusion events (1 or more red cell units transfused to patient), we found suboptimal documentation of nearly half, the majority of which could not be justified in retrospective audits.Documentation improvement could enhance blood utilization assessment efficiency and reduce inappropriate transfusions.Due to these issues as well as inherent risks of transfusion and escalating costs, our hospital remains focused on improving blood utilization.Indeed,The Joint Commission, which accredits healthcare organizations in the U.S., has recently finalized its Patient Blood Management Performance Measures, covering 7 measures including transfusion consent, indications, and documentation.Thus, we have initiated a more aggressive blood management program, including prospective intervention to reduce inappropriate red cell transfusions (already in use for non-red cell products) as well as education for noncompliant physicians, with initial goal to reduce overall non-emergent red cell transfusions (exclusive of emergency department,intensive care units, and operating suite) by 5% for estimated cost savings over $50,000 USD.