Blood ordering habits for elective surgery: time for change

Area of Science:

• Transfusion Medicine
• Surgical Safety
• Healthcare Management

Background:

• Current blood ordering routines for elective surgery often lead to unnecessary preoperative crossmatching.
• Over-ordering of blood products contributes to increased healthcare costs and potential waste.
• Assessing the actual need for blood transfusions is crucial for optimizing resource allocation.

Purpose of the Study:

• To evaluate the efficacy of existing blood ordering protocols for elective surgical procedures.
• To determine the actual transfusion requirements versus the volume of blood crossmatched preoperatively.
• To propose a revised transfusion strategy to improve efficiency and reduce unnecessary blood preparation.

Main Methods:

• A prospective study was conducted over a 6-month period.
• Data collected included the number of procedures, preoperative crossmatches, and actual transfusions.
• Transfusion Index (TI) and crossmatch/transfusion ratio were calculated to assess blood usage efficacy.

Main Results:

• Only 23% of procedures required preoperative crossmatching (TI > 0.5).
• Excessive over-ordering was observed in 77% of operations (crossmatch/transfusion ratio > 2.5).
• A significant proportion of crossmatched blood (TI < 0.5) was not needed preoperatively.

Conclusions:

• Current blood ordering practices for elective surgery are largely inefficient, with substantial over-ordering.
• A 'group and screen' policy is recommended over routine crossmatching for many procedures.
• Implementing a revised transfusion tariff can optimize blood resource management and reduce costs.