title: The practical utility of routine postpartum hemoglobin assessment.
abstract: OBJECTIVE
  To evaluate a policy of routine versus selective postpartum complete blood count (CBC).
  
  
  METHODS
  Historic case control design with matched subjects from 1 year periods bracketing the policy change (n = 800). Our primary outcome was postpartum transfusion rate. Univariable and multivariable analyses were performed. Total hospital costs were estimated.
  
  
  RESULTS
  Eliminating routine postpartum CBC testing was associated with decreased transfusion rates (5.5% vs 1.8%, P = .007) despite similar transfusion risks. CBC utilization decreased from 59% to 22.2% (P < .0001). No adverse bleeding outcomes occurred. Multivariable modeling suggested that the occurrence of postpartum hemorrhage was the best clinical predictors of transfusion n risk. Tachycardia, oliguria, and symptoms were also effective at identifying transfusion candidates. Elimination of routine CBC was independently associated with a reduced risk of transfusion (odds ratio, 0.30; 95% confidence interval, 0.12-0.72). Annual cost savings were estimated at $58,000.
  
  
  CONCLUSIONS
  Targeted CBC testing results in fewer transfusions, lower costs and improved quality of patient care.
authors.affiliation: Department of Obstetrics and Gynecology, Medical University of South Carolina, Charleston, SC.
authors.forename: Hannah B
authors.initials: HB
authors.lastname: Steele
authors.affiliation: Department of Obstetrics and Gynecology, Medical University of South Carolina, Charleston, SC.
authors.forename: Laura
authors.initials: L
authors.lastname: Goetzl
mesh_terms: D000328:Adult; D001772:Blood Cell Count / Q000191:economics / Q000706:statistics & numerical data*; D001803:Blood Transfusion / Q000191:economics / Q000706:statistics & numerical data*; D016022:Case-Control Studies; D003365:Costs and Cost Analysis / Q000379:methods; D005260:Female; D006454:Hemoglobins / Q000032:analysis*; D017721:Hospital Costs / Q000706:statistics & numerical data*; D006801:Humans; D016015:Logistic Models; D009775:Obstetrics and Gynecology Department, Hospital / Q000191:economics / Q000706:statistics & numerical data*; D061214:Patient Safety; D011181:Postnatal Care / Q000191:economics / Q000379:methods*; D017410:Practice Guidelines as Topic; D011247:Pregnancy; D012189:Retrospective Studies
chemical_list: D006454:Hemoglobins
keywords: complete blood count; cost analysis; postpartum care; transfusion