A Circular of Information (COI) Update Taskforce is currently in the process of reviewing the COI for possible revisions. A practicing anesthesiologist who works at an academic center in Pennsylvania feels that regardless of what revisions might be made on the commentary, a major effort is needed is to increase the visibility of the COI. His sense is that few clinicians who order blood have ever seen or heard of the COI. To prove this point, he recently sent an email to all of the anesthesiologists within a University-based health system in his community, which includes 12 hospitals and approximately 250 anesthesiologists. Of the first two dozen responses so far, not a single respondent had heard of, nor seen this Circular of Information. One of the respondents was the Vice Dean of a medical school who felt that this would be something which would be important to get to medical students and residents. As an anesthesiologist, he acknowledges that he does not know what kind of statutory requirements are being met by this circular, but he thinks a primary goal of the COI Update Taskforce should be to focus on getting better visibility of the document.

The following comments have been received.

ADDENDA Dec. 22, 2005

1. A nursing director of a blood conservation program in a New Jersey hospital reports that she is very familiar with the COI, and views the COI as a valuable resource and source of information. She agrees that this tool should be in the hands of anyone involved with blood ordering. She personally would like to have hundreds of copies for distribution within her hospital. She would envision distributing them to medical students, residents, attendings, anesthesiologists and for each nursing unit.

2. A transfusion medicine physician in Ohio reports that many years ago she did her own survey of clinicians to determine awareness of the COI. In general, clinicians were not aware of the COI. For example, when she gave a Grand Rounds before an Anesthesia Department, only one or two of about 100 physicians in attendence had ever heard of the COI, and not even one of them had actually seen it! She agrees with the Pennsylvania anesthesiologist that the visibility of the COI must be improved if end-users, for whom the COI is intended, are to benefit. She is trying to do her part by educating housestaff about the COI when she gives an annual orientation talk to new house officiers each June. She laments that in her experience it is the medical malpractice attorneys who seem to know more about the COI than most physicians!

3. Ronald E. Domen, MD, Medical Director, Blood Bank and Transfusion Medicine at the Milton S. Hershey Medical Center of Penn State University College of Medicine (attribution used with permission) agrees that the COI is probably less visible than it could/should be. He acknowledges that when he gives blood component lectures to medical students, every student gets a copy of the COI and he explains what it is. He does the same on those occasions that he gets to talk to various resident groups about blood usage. In his opinion, part of the problem is a lack of a forum for transfusion medicine specialists to get the message out.

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Ira A. Shulman, MD
CBBS e-Network Forum Editor & Moderator