Tailoring the Blood Ordering Process for Cardiac Surgical Cases Using an Institution-Specific Version of the Maximum Surgical Blood Order Schedule.
BACKGROUND
Excess ordering of blood products for surgical cases is expensive and wasteful. Evidence has shown that institution-specific versions of the Maximum Surgical Blood Order Schedule (MSBOS) lead to better ordering practices. Most MSBOSs recommend a crossmatch for a minimum of 2 units of packed red blood cells (PRBCs) for cardiac surgical cases; however, studies have shown that >50% of these patients receive no transfusions. Our aim was to create a blood order algorithm for cardiac surgical cases that would decrease unnecessary crossmatching.


METHODS
Retrospective data was collected for 264 patients from January 2011 through April 2012. The crossmatch-to-transfusion ratio (C:tx), transfusion probability (%T), and transfusion index (TI) were calculated for each type of procedure.


RESULTS
All 264 patients were crossmatched and 98 patients were transfused, resulting in an overall transfusion probability (%T) of 37.12% (95% confidence interval 31.52-43.09). A total of 1175 units of blood were crossmatched, but only 370 units of blood were transfused, resulting in a C:tx of 3.17 (95% confidence interval 2.61-4.03). The average number of units transfused per procedure (transfusion index) was 1.40. C:tx was highest and TI was lowest for CABG, where approximately 11 units of blood were ordered for every 1 unit transfused (C:tx =11.70 ± 3.04), and the TI was 0.32.


CONCLUSIONS
Using the gold standard C:tx of >2:1 as an indicator of inappropriate blood utilization, our analysis confirmed that excessive crossmatching occurred for several procedures. Now a subset of cardiac surgical cases only requires a type and screen order prior to surgery.
Ochsner Clinic Foundation, New Orleans, LA, USA kellyural@gmail.com.
Kelly Graham
KG
Ural
Ochsner Clinic Foundation, New Orleans, LA, USA.
Jacqueline
J
Volpi-Abadie
Ochsner Clinic Foundation, New Orleans, LA, USA.
Garrett
G
Owen
Ochsner Clinic Foundation, New Orleans, LA, USA.
George
G
Gilly
Ochsner Clinic Foundation, New Orleans, LA, USA.
Allison L
AL
Egger
Ochsner Clinic Foundation, New Orleans, LA, USA.
Heather
H
Scuderi-Porter
D000328:Adult; D000465:Algorithms; D001788:Blood Grouping and Crossmatching; D016063:Blood Loss, Surgical; D001803:Blood Transfusion / Q000379:methods* / Q000706:statistics & numerical data; D006348:Cardiac Surgical Procedures / Q000379:methods* / Q000706:statistics & numerical data; D002315:Cardiopulmonary Bypass / Q000379:methods / Q000706:statistics & numerical data; D003430:Cross-Sectional Studies; D005260:Female; D016027:Heart Transplantation / Q000379:methods; D006400:Hematocrit; D006801:Humans; D008297:Male; D012189:Retrospective Studies
blood loss; cardiac surgery; cardiopulmonary bypass; transfusion