Maximizing the benefits of type and screen by continued surveillance of transfusion practice

The use of type and screen (T&S) has reduced our overall crossmatch:transfusion (C:T) ratio from 2.5:1 prior to T&S to 1.9:1. Review of our progress, however, demonstrated only a partial reduction of C:T for elective cholecystectomy from 103:1 to 18:1, with only 39% T&S utilization. In addition, units crossmatched in excess of the surgical schedule for 174 high-risk patients had a C:T ratio of 18.6:1. Routine questioning of all excess orders proved unacceptable to blood bank staff and surgeons. An inflexible schedule was also deemed unacceptable. We therefore began monthly written summary reports to each surgical division listing each case in which extra crossmatching was reported and whether the units requested were transfused. These reports enabled the surgical directors to help monitor crossmatch utilization. In addition, we have reduced our C:T ratio of extra units for 405 high-risk patients to 4.0:1. T&S utilization for elective cholecystectomy has increased to 64%, and C:T has fallen to 9:1. These results demonstrate that establishing T&S can reduce the C:T ratio and patient costs; but continued attention is required to maximize the benefits of this procedure.