title: Cost and quality in the use of blood bank services for normal deliveries, cesarean sections, and hysterectomies.
abstract: To reduce costs, preserve blood supplies, and enhance the safety of blood use during emergencies, the Department of Obstetrics and Gynecology and the blood bank at a teaching hospital recommended replacing pre-delivery crossmatch on selected patients with typing and screening for all patients undergoing normal or cesarean section delivery. Using an automated data system, it was shown that 75% and 50% reductions in the ordering of crossmatching for these two groups of patients promptly resulted, endured over a one-year follow-up period, and also spread to include patients undergoing hysterectomy. However, the cost of the increased use of typing and screening outweighed the reduced cost of crossmatching: actual annual costs increased by $11 151. We conclude that test-ordering practices can be changed surprisingly easily if a specific and reasonable policy is advocated by influential clinicians. However, changes in test use can cause unexpected cost increases. Only detailed study of practice patterns can reveal cost consequences for a specific institution.
mesh_terms: D001788:Blood Grouping and Crossmatching / Q000379:methods*; D001803:Blood Transfusion / Q000191:economics / Q000706:statistics & numerical data*; D001900:Boston; D002585:Cesarean Section; D003363:Cost Control; D036861:Delivery, Obstetric; D017707:Erythrocyte Transfusion; D005260:Female; D006746:Hospital Bed Capacity, 500 and over; D006801:Humans; D007044:Hysterectomy; D008485:Medical Audit; D011247:Pregnancy