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Multicenter Study
. 2025 Apr;120(4):411-418.
doi: 10.1111/vox.13804. Epub 2025 Feb 25.

A maximum surgical blood ordering schedule: Does it add value?

Deborah L Benzil  1 , Moises Auron  2   3   4 , Zaher K Otrock  5 , Daniel Lallo  6 , Noreen Flowers  7 , Kenneth Cummings 3rd  3   8 , NurJehan Quraishy  9 , Deborah Tolich  6
Affiliations
Multicenter Study

A maximum surgical blood ordering schedule: Does it add value?

Deborah L Benzil et al. Vox Sang. 2025 Apr.

Abstract

Background and objectives: Implementing and complying with a maximum surgical blood ordering schedule (MSBOS) is challenging but essential to avoid waste and reduce costs. MSBOS helps manage blood product scarcity and healthcare expenditure by avoiding unnecessary pre-transfusion testing and preparation, reducing product waste and improving clinical and operational efficiencies while maintaining patient safety.

Materials and methods: A multi-hospital health system in Ohio and Florida performing more than 200,000 surgeries annually implemented MSBOS through a risk-stratified protocol and electronic medical record automation.

Results: The first-year analysis included 107,149 cases in 23 surgical specialties and 18 hospitals. Compliance with MSBOS improved over time, reducing type and screen tests by 4166 and saving $223,839 in costs. No patient safety issues were identified.

Conclusion: This project demonstrates that adopting MSBOS in a large health system adds value by reducing unnecessary testing and costs while maintaining patient safety.

Keywords: MSBOS (maximum surgical blood ordering system); cost savings; high‐value care; patient safety; type and screen.

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Conflict of interest statement

The authors declare no conflicts of interest.

Figures

FIGURE 1
FIGURE 1
Maximum surgical blood ordering schedule (MSBOS) compliance over time. Time intervals are post implementation: 1 = 3 months, 2 = 6 months and 3 = 9 months. Representation of one hospital location and institute or a grouping of similar service lines.
FIGURE 2
FIGURE 2
Each hospital location, represented by the degree of change between pre implementation and post implementation.
FIGURE 3
FIGURE 3
Best practice alert. Alert fires when a patient is scheduled for a procedure that does not require a type and screen. The ordering, the provider may override by indicating a reason to continue ordering the test. Wrong provider, wrong time in workflow and wrong alert logic are standard reasons for override.
FIGURE 4
FIGURE 4
Best practice alert overrides. Alerts = number of alerts fired; acceptable = number for reasons for bleeding disorder, anaemia, high risk for transfusion, and atypical antibodies; percentage acceptable of total alerts.
See this image and copyright information in PMC

References

    1. Sadana D, Pratzer A, Scher LJ, Saag HS, Adler N, Volpicelli FM, et al. Promoting high‐value practice by reducing unnecessary transfusions with a patient blood management program. JAMA Intern Med. 2018;178:116–122. - PubMed
    1. Hayn D, Kreiner K, Ebner H, Kastner P, Breznik N, Rzepka A, et al. Development of multivariable models to predict and benchmark transfusion in elective surgery supporting patient blood management. Appl Clin Inform. 2017;8:617–631. - PMC - PubMed
    1. Dexter F, Ledolter J, Davis E, Witkowski TA, Herman JH, Epstein RH. Systematic criteria for type and screen based on procedure's probability of erythrocyte transfusion. Anesthesiology. 2012;116:768–778. - PubMed
    1. Frank SM, Oleyar MJ, Ness PM, Tobian AA. 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. Anesthesiology. 2014;121:501–509. - PMC - PubMed
    1. Collins RA, Wisniewski MK, Waters JH, Triulzi DJ, Alarcon LH, Yazer MH. Excessive quantities of red blood cells are issued to the operating room. Transfus Med. 2015;25:374–379. - PubMed

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