title: Excessive quantities of red blood cells are issued to the operating room.
abstract: OBJECTIVE
  To determine what percentage of red blood cell (RBC) units that were issued to the operating room (OR) were returned unused, and to determine how often all of the RBCs that were issued for a patient were returned unused using the institution's maximum surgical blood ordering schedule (MSBOS) as a guide.
  
  
  BACKGROUND
  The MSBOS provides guidelines for blood ordering, but is merely a suggestion for the ordering clinicians. This study examined how closely ordering practices followed the MSBOS, and how often ordered RBCs were actually transfused.
  
  
  METHODS
  For a 4-week period, RBC issue and utilization data were collected on elective surgery patients who were eligible for electronic cross-match at a tertiary care hospital. These data were compared to the MSBOS.
  
  
  RESULTS
  There were 1350 surgical procedures performed. Of these cases, 439 patients had a type and screen (T&S) performed, and 215/439 (49%) patients had at least 1 RBC issued during their case. To these 215 patients, 742 RBC units were issued and 537/742 (72%) of these units were returned to the blood bank unused. In 152/215 (71%) cases with issued RBCs, all of the RBCs were returned to the blood bank unused. Amongst the surgical categories in this study, the percentage of cases where none of the issued RBCs were transfused ranged from 38 to 93%.
  
  
  CONCLUSIONS
  Significant numbers of RBC units are issued but not transfused during surgery. Involving the surgical team in the blood issuing process and using a data-driven MSBOS may reduce the number of unused units.
authors.affiliation: Department of Pathology, University of Pittsburgh.
authors.forename: R A
authors.initials: RA
authors.lastname: Collins
authors.affiliation: The Donald D. Wolff Jr. Center for Quality, Safety, and Innovation, UPMC.
authors.forename: M K
authors.initials: MK
authors.lastname: Wisniewski
authors.affiliation: Departments of Anesthesiology, Bioengineering and the McGowan Institute for Regenerative Medicine, University of Pittsburgh.
authors.forename: J H
authors.initials: JH
authors.lastname: Waters
authors.affiliation: Department of Pathology, University of Pittsburgh.|The Institute for Transfusion Medicine.
authors.forename: D J
authors.initials: DJ
authors.lastname: Triulzi
authors.affiliation: Departments of Surgery and Critical Care Medicine, University of Pittsburgh, Pittsburgh, PA.
authors.forename: L H
authors.initials: LH
authors.lastname: Alarcon
authors.affiliation: Department of Pathology, University of Pittsburgh.|The Institute for Transfusion Medicine.
authors.forename: M H
authors.initials: MH
authors.lastname: Yazer
mesh_terms: D017707:Erythrocyte Transfusion; D004912:Erythrocytes; D005260:Female; D006801:Humans; D007430:Intraoperative Care; D008297:Male
keywords: maximum surgical blood ordering schedule; operating room; red blood cell transfusion