title: Measuring trade-offs that matter: assessing the impact of a new electronic cross-match policy on the turnaround time and the cross-match workload efficiency.
abstract: BACKGROUND
  Our traditional cross-match (XM) policy generated a significant number of XM units that were never issued. To minimize the unnecessary XM workload, we proposed a new policy where orders eligible for the electronic XM (EXM) are pended until orders to issue red blood cells (RBCs) are received. To address concerns that this new policy might unduly delay blood availability, we conducted a study to assess whether the new policy was noninferior to the traditional policy with regard to the turnaround time (TAT).
  
  
  METHODS
  We monitored the TAT and XM workload efficiency (XM-to-issue [C : I] ratio) for a total of 8 weeks split between the two policies' periods. The primary outcome was the proportion of RBC issue requests that was turned around in less than 12 minutes.
  
  
  RESULTS
  Fifty percent (1133 of 2265) of issue requests were turned around in 12 minutes or less under the traditional policy compared to 43.9% (975 of 2223) under the new policy (absolute difference of 6.1%; 95% confidence interval [CI], 3.2%-9.1%; p < 0.001). The adjusted overall median TAT was slower by 1 minute (13 min vs. 14 min, p < 0.001) but the adjusted C : I ratio was better (1.00 vs. 1.15; p < 0.001) under the new policy.
  
  
  CONCLUSIONS
  Our study showed that the impact of the new policy on the TAT was not inferior to the traditional policy. Since the median TAT of 14 minutes under the new policy met the published benchmarks, the trade-off between delays in the TAT and efficiency gains in the XM workload remained acceptable for patient care.
authors.affiliation: Division of Transfusion Medicine, Department of Pathology and Laboratory Medicine, David Geffen School of Medicine at UCLA, Los Angeles, California.
authors.forename: David M
authors.initials: DM
authors.lastname: Lin
authors.forename: Dennis
authors.initials: D
authors.lastname: Goldfinger
authors.forename: Qun
authors.initials: Q
authors.lastname: Lu
authors.forename: Bridget
authors.initials: B
authors.lastname: Wallace
authors.forename: Dawn
authors.initials: D
authors.lastname: Kosaka-Nguyen
authors.forename: Alisa
authors.initials: A
authors.lastname: Wood
authors.forename: Bethany
authors.initials: B
authors.lastname: Porter
authors.forename: Pamela
authors.initials: P
authors.lastname: Bumerts
authors.forename: Rebecca
authors.initials: R
authors.lastname: Jeffery
authors.forename: Amy
authors.initials: A
authors.lastname: Fang
authors.forename: Irene
authors.initials: I
authors.lastname: Stalcup
authors.forename: Tracy
authors.initials: T
authors.lastname: Penaflorida
authors.forename: Alyssa
authors.initials: A
authors.lastname: Ziman
mesh_terms: D001787:Blood Group Incompatibility / Q000517:prevention & control*; D001788:Blood Grouping and Crossmatching / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D016347:Medical Records Systems, Computerized; D011050:Policy Making; D016526:Workload