Revision and Implementation of a Maximum Surgical Blood Ordering Schedule in a Large Acute Hospital
The aim of this change management project was the implementation of a Maximum Surgical Blood Ordering Schedule (MSBOS). Institutional MSBOS’s utilised in many hospitals provide a template recommendation for crossmatching of red blood cells for a broad range of surgical procedures; however, for many lower risk surgical procedures these requirements are almost negligible.
This project utilised the HSE Change model to implement a new guideline for elective procedures. Recommendations were taken from literature and stated for any elective procedure having greater than 19 cases (N ≥ 19) the following rules would apply: transfusion rate less than 5% requires no type and screen specimen processed, transfusion rate between 5%-30% a specimen is processed and no red blood cells crossmatched, and for procedures with a transfusion rate above 30% a specimen is required and red blood cells crossmatched.
Evaluation results were successful with a reduction seen in the number of type and screen specimens proceed by the laboratory and a reduction in the number of red blood cells crossmatched. The elimination of routine type and screen specimens for these procedures and the resultant change to the hospital’s MSBOS could potentially result in an estimated saving of € 47,000 per year.
In conclusion, in the absence of a preoperative indication, routine type and screen specimens should be eliminated for select lower risk surgical procedures along with a selective approach for ordering red blood cells in higher risk procedures. The benefits in workload and cost saving mean such measures should be implemented in all hospitals with a Blood Transfusion Department.