Background
Using blood utilization data acquired from our anesthesia information management system, an updated institution-specific maximum surgical blood order schedule (MSBOS) was introduced. We evaluate whether the MSBOS, along with a remote electronic blood release system (EBRS), reduced unnecessary preoperative blood orders and costs.
Methods
At a large academic medical center, data for preoperative blood orders were analyzed for 63,916 surgical patients over a 34-month period. The new MSBOS and the EBRS (Hemosafe®, Haemonetics Corp., Braintree, MA) were introduced mid-way through this time period. We assessed whether these interventions led to reductions in unnecessary preoperative orders and associated costs.
Results
Among patients having surgical procedures deemed not to require a type and screen or crossmatch (n = 33,216), the percentage of procedures with preoperative blood orders decreased by 38% [from 40.4% (7,167 of 17,740 patients) to 25.0% (3,869 of 15,476 patients), P < 0.001]. Among all hospitalized inpatients, the crossmatch-to-transfusion ratio decreased by 27% (from 2.11 to 1.54; P < 0.001) over the same time period. The proportion of patients who required emergency release uncrossmatched blood increased from 2.2 to 3.1 per 1,000 patients (P = 0.03); however, most of these patients were having emergency surgery. Based on the realized reductions in blood orders, annual costs were reduced by $137,223 ($6.08/patient) for surgical patients, and by $298,966 ($6.20/patient) for all hospitalized patients.
Conclusions
Implementing institution-specific, updated MSBOS-directed preoperative blood ordering guidelines along with an EBRS results in a substantial reduction in unnecessary orders and costs, with a clinically insignificant increase in requirement for emergency release blood transfusions.
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