title: 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.
abstract: BACKGROUND
  Using blood utilization data acquired from the anesthesia information management system, an updated institution-specific maximum surgical blood order schedule was introduced. The authors evaluated whether the maximum surgical blood order schedule, along with a remote electronic blood release system, reduced unnecessary preoperative blood orders and costs.
  
  
  METHODS
  At a large academic medical center, data for preoperative blood orders were analyzed for 63,916 surgical patients over a 34-month period. The new maximum surgical blood order schedule and the electronic blood release system (Hemosafe; Haemonetics Corp., Braintree, MA) were introduced mid-way through this time period. The authors assessed whether these interventions led to reductions in unnecessary preoperative orders and associated costs.
  
  
  RESULTS
  Among patients having surgical procedures deemed not to require a type and screen or crossmatch (n = 33,216), the percent of procedures with preoperative blood orders decreased by 38% (from 40.4% [7,167 of 17,740 patients] to 25.0% [3,869 of 15,476 patients], P < 0.001). Among all hospitalized inpatients, the crossmatch-to-transfusion ratio decreased by 27% (from 2.11 to 1.54; P < 0.001) over the same time period. The proportion of patients who required emergency release uncrossmatched blood increased from 2.2 to 3.1 per 1,000 patients (P = 0.03); however, most of these patients were having emergency surgery. Based on the realized reductions in blood orders, annual costs were reduced by $137,223 ($6.08 per patient) for surgical patients, and by $298,966 ($6.20/patient) for all hospitalized patients.
  
  
  CONCLUSIONS
  Implementing institution-specific, updated maximum surgical blood order schedule-directed preoperative blood ordering guidelines along with an electronic blood release system results in a substantial reduction in unnecessary orders and costs, with a clinically insignificant increase in requirement for emergency release blood transfusions.
authors.affiliation: From the Department of Anesthesiology and Critical Care Medicine (S.M.F., M.J.O.); and Department of Pathology, Division of Transfusion Medicine (P.M.N., A.A.R.T.), The Johns Hopkins Medical Institutions, Baltimore, Maryland.
authors.forename: Steven M
authors.initials: SM
authors.lastname: Frank
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Oleyar
authors.forename: Paul M
authors.initials: PM
authors.lastname: Ness
authors.forename: Aaron A R
authors.initials: AA
authors.lastname: Tobian
mesh_terms: D000328:Adult; D000368:Aged; D000758:Anesthesia; D001771:Blood Banks; D001788:Blood Grouping and Crossmatching / Q000295:instrumentation; D001803:Blood Transfusion / Q000191:economics / Q000379:methods*; D017046:Cost Savings; D001330:Electronic Data Processing; D005260:Female; D006801:Humans; D019451:Information Management; D008297:Male; D008875:Middle Aged; D011300:Preoperative Care; D012189:Retrospective Studies; D012984:Software