title: Blood audit evidenced-based cross-match requesting for lumbar spine surgery.
abstract: METHODS
  Complete audit cycle.
  
  
  OBJECTIVE
  Radical overhaul of the blood ordering practices made by the spinal surgery department, in order to maximize the efficient use of blood products.
  
  
  BACKGROUND
  Spinal surgeons request blood-based on historical practice and not evidence. Blood is a scarce resource. Provision relies on voluntary donations from the general population. However, the donor population has been reduced because of the risks of variant Creutzfeldt-Jakob disease. Hence, the responsibility rests with clinicians to optimize their management of blood.
  
  
  METHODS
  The spinal surgery department database was accessed to identify all patients who underwent elective lumbar spine operations (excluding deformity) during 2002 to 2003. These records were then cross-referenced with the blood transfusion department database. From the results the cross-match to transfusion (C:T) ratios and transfusion indexes (TI) were calculated for the procedures. A new tariff was agreed between the surgeons, anesthetists, and transfusion department. This was then audited prospectively.
  
  
  RESULTS
  There were 664 cross-match requests made during 2002 to 2003, and only 40 U was transfused. This gave a C:T ratio of 16.6:1. The prospective audit resulted in only 58 U being cross-matched and 5 were transfused. This reduced the C:T ratio to 11.5:1.
  
  
  CONCLUSIONS
  Implementing evidence based cross-match protocols can make significant savings in time, manpower, and money.
authors.affiliation: Department of Trauma and Orthopaedic Surgery, Derriford Hospital, Plymouth, UK. kluver_bucy@hotmail.com
authors.forename: Andrew
authors.initials: A
authors.lastname: Clarke
authors.forename: Michael
authors.initials: M
authors.lastname: O'Malley
authors.forename: James F
authors.initials: JF
authors.lastname: Hegarty
authors.forename: Brian J C
authors.initials: BJ
authors.lastname: Freeman
mesh_terms: D001788:Blood Grouping and Crossmatching / Q000706:statistics & numerical data; D001803:Blood Transfusion / Q000706:statistics & numerical data; D016208:Databases, Factual; D019317:Evidence-Based Medicine; D006801:Humans; D008159:Lumbar Vertebrae / Q000601:surgery*; D008485:Medical Audit; D011446:Prospective Studies