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. 2014 Sep;121(3):501-9.
doi: 10.1097/ALN.0000000000000338.

Reducing unnecessary preoperative blood orders and costs by implementing an updated institution-specific maximum surgical blood order schedule and a remote electronic blood release system

Steven M Frank  1 , Michael J Oleyar, Paul M Ness, Aaron A R Tobian
Affiliations

Reducing unnecessary preoperative blood orders and costs by implementing an updated institution-specific maximum surgical blood order schedule and a remote electronic blood release system

Steven M Frank et al. Anesthesiology. 2014 Sep.

Abstract

Background: Using blood utilization data acquired from the anesthesia information management system, an updated institution-specific maximum surgical blood order schedule was introduced. The authors evaluated whether the maximum surgical blood order schedule, along with a remote electronic blood release system, 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 maximum surgical blood order schedule and the electronic blood release system (Hemosafe; Haemonetics Corp., Braintree, MA) were introduced mid-way through this time period. The authors 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 percent 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 per patient) for surgical patients, and by $298,966 ($6.20/patient) for all hospitalized patients.

Conclusion: Implementing institution-specific, updated maximum surgical blood order schedule-directed preoperative blood ordering guidelines along with an electronic blood release system 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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Figures

Fig. 1
Fig. 1
Blood ordering practices from the periods before and after release of the updated, institution-specific MSBOS and EBRS were implemented in July 2012. (A) Among patients undergoing surgical procedures in the “no sample needed” category of the MSBOS, blood orders considered to be unnecessary (type and screen and type and cross combined) decreased by 38.1%. (B) For all surgical cases, blood orders decreased by 17.8%. (C) For all hospitalized patients, there was a concomitant decrease in the crossmatch-to-transfusion ratio (C/T ratio). EBRS = remote electronic blood release system, MSBOS = maximum surgical blood order schedule.
Fig. 2
Fig. 2
A comparison of preoperative blood orders in the pre-MSBOS / EBRS and post-MSBOS / EBRS time periods among all surgical patients. (A) The percentage of patients who received type and screen and type and crossmatch orders decreased while the percentage of patients with no preoperative blood orders increased. (B) This change in practice was associated with a small increase of one additional patient per thousand that required emergency release type-O, uncossmatched erythrocyte transfusion. EBRS = remote electronic blood release system, MSBOS = maximum surgical blood order schedule.
Fig. 3
Fig. 3
The total number of preoperative blood orders placed on the day of surgery (same-day blood sample orders) is shown for each month in the study period. Although the total number of same-day blood orders did not change over time, the number of same-day preoperative blood orders considered to be unnecessary decreased, especially after audits were conducted to inform providers when preoperative blood orders were considered to be unnecessary. MSBOS = maximum surgical blood order schedule.
Fig. 4
Fig. 4
Annualized costs for type and screen and type and crossmatch blood orders are shown for all surgical and all hospitalized patients included in the study. After implementation of the MSBOS and EBRS, annual costs decreased by $137,223 in surgical patients ($6.08/patient) and by $298,966 ($6.20/patient) in all hospitalized patients. EBRS = remote electronic blood release system, MSBOS = maximum surgical blood order schedule.
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