Evaluating the Benefits of an Updated Blood Ordering Process

Evidence-based medicine optimizes patient care to provide appropriate patient oversite. By providing the patient with treatment that has benefits, blood management programs have decreased blood component utilization1,2 and stimulated treatment plans that span the continuum of care, from prior to hospital admission through patient discharge.2 Evidence-based medicine is not a new concept nor is the concept of providing the patient with tailored care. In the 1970's, the concept of matching cross-matched red cell inventory to the needs of the patient stimulated studies that led to the maximum surgical blood-ordering schedule.3,4 Also, by pairing cross-match inventory to the patient's transfusion requirements, a blood bank tool was created to assist in patient-care, controlling red cell unit inventory, and reducing cost.3 Patient-care changes have further evolved since the 1970's. Medical innovations today have minimized surgical blood loss through the use of laparoscopy, hemostatic agents, and improved surgical techniques. The blood bank has also evolved techniques to decrease the time it takes to provide blood to the patient. With the advancement in transfusion service testing and computer technology, blood ordering schedules can be customized to the institution, to the surgical procedure, and to the individual patient. An updated maximum surgical blood ordering schedule can further assist in optimizing compatibility testing orders, minimize component waste, and associated cost based on current evidence-based, best practice patient-care. This article will discuss the benefits of an updated blood-ordering schedule. ABBREVIATIONS: MSBOS - Maximum surgical blood ordering schedule, NBCUS - National Blood Collection and Utilization Survey, C:T - Crossmatch to Transfusion ratio, THR - total hip replacement; TKR - total knee revision, EBL - estimated blood loss, PSBOS - Patient –specific blood ordering system, SBOE - surgical blood order equation