The Maximum Surgical Blood Order Schedule and Surgical Blood Use in the United States

Abstract

The outdating of units of blood can be reduced by decreasing the amount of time they spend in an assigned or crossmatched status. This reduction can be achieved in a hospital by establishing a maximum surgical blood order schedule (MSBOS) which reduces the excessive number of units of blood crossmatched preoperatively for patients undergoing elective surgery. The various steps which occurred in the development of a MSBOS in a large general hospital are detailed and the projected reduction in the number of crossmatched units which can be achieved with the MSBOS is illustrated. The projected number of units of blood transfused to patients during their hospitalization for 50 common primary surgical procedures in the United States during 1974 is presented as a basis for defining maximum blood orders for each procedure.

Blood Use in Neurosurgical Cases at University Hospital of the West Indies

“…The MSBOS would increase blood availability by decreasing the time each unit spends in an assigned or cross-matched status. Several studies have demonstrated that significant advantages accrue from instituting an MSBOS (5,7,8): a decrease in the CTR, increased accessibility of blood and significant savings in staff time, reagents and money. Recently, it has been suggested that the blood order should be personalized for each patient in order to increase efficiency further (23).…”

“…Cross-matching renders units unavailable to other patients and thus increases the risk of them becoming outdated (5). Elective surgical procedures have been postponed in cases where blood is absent and this increases the costs to both patient and institution.…”

Blood Ordering Strategies in the Armed Forces — A Proposal

“…This is a criterion developed from institutional usage statistics providing a figure for the number of units to be cross matched for any given surgical procedure [2]. The idea of providing pre surgical testing, without cross matching, for elective surgery without significant blood loss is not new.…”

“…The practice of establishing MSBOS has been observed to be highly successful [1,2]. In this, the data concerning blood usage for each procedure performed in the hospital is reviewed over several months and the C/T ratio calculated.…”

“…The principles behind the development of a standardized schedule for preoperative blood ordering, or MSBOS, popularized by Friedman et al [2] are closely related to those which led to a 'T & S' approach. Indeed, the two concepts are usually combined when guidelines for blood ordering are provided to the staff of the hospital.…”