Use of Blood in Elective Surgery: An Area of Wasted Hospital Resource

Abstract

Unavailability of blood is a common cause of canceled operations but clinicians' blood ordering habits have been shown to waste hospital resources. A prospective audit was set up in a blood bank in a teaching hospital in Saudi Arabia. Data were separately logged on blood transfusion for all surgical operations between August 1991 and December 1992. Standard terminology was employed. During the 16 months, 565 consecutive operations were logged. Only two of eight departments met the criterion of efficient blood ordering, vis-a-vis a C:T ratio (units crossmatched divided by units transfused) of 2.5:1. Similarly, in the four most frequently performed operations, the transfusion index (Ti) was <0.25, indicating that blood would have been required for <25% of these cases. The study confirms others' experience of inefficiency in blood ordering for surgical operations, plus its attendant waste of resources. It is recommended that unless written and binding guidelines are published on a nationwide basis, clinicians' inefficient methods in ordering blood are unlikely to alter rapidly. Ann Saudi Med 1994;14(4):326-328. Resource. 1994; 14(4): 326-328 Since the introduction of blood transfusion into clinical practice, its appropriate use has been a subject for debate. Dodsworth and Dudley 1 reported that only 30% of the blood crossmatched for routine surgery was used and that many operations were being canceled, an event that the government of the United Kingdom now intends to use as an indicator of a hospital's performance. In a recent study from Saudi Arabia, Magbool et al. SA. Sowayan, Use of Blood in Elective Surgery: an Area of Wasted Hospital2 found that canceled operations were frequent and unavailability of blood was the third most common cause.However, surgeons' blood ordering habits are such that supplies, reagents, and technicians' time are committed and can be wasted. Thus, it has been shown from the United Kingdom, 1,3-6 the United States of America, [7][8][9][10] Australia, 11 Kuwait,12,13 and Saudi Arabia 14 that if clinicians' blood ordering habits were rationed, savings would accrue without patients being harmed. For example, Al-Momen et al.14 estimated that an annual savings of 312,000 Saudi Riyals (approximately US $83,000) would accrue in one hospital alone if its blood transfusion services were appropriately used. They concluded, "We are not making the most efficient use of blood bank facilities", and added, "it is most unlikely that we are alone in this regard and we urge . . . other hospitals to review their current blood ordering policies".The purpose of this audit was to determine the efficiency of our surgeons' use of blood transfusions with particular reference to common operations for which blood is routinely ordered. We intend to use the information as a basis for revising our policies on blood ordering for surgical procedures. We also have reason to believe that our findings will be of general interest. Patients and MethodsA prospective survey was conducted in the King Fahd Hospital of the Un...

A Prospective Study on Blood Requisition and Utilization Practice in a Tertiary Care Teaching Hospital

“…A value of 0.5 or more is suggestive of efficient blood usage. 20 The present study reported a TI value of 0.87. Ebose and Osalumese reported a TI of below 0.5.…”

Study of the Ratio of Cross-Matching to Transfusion of Blood or Blood Component, I.E. Packed Red Blood Corpuscles to Develop Good Practices for the Utilisation of Blood

“…It has been reported that only 30% of cross-matched blood is used in elective surgery. [8] Therefore, it is essential that the usage of blood and blood products should be rationalised and saved for critical situations. [7] According to this recommendation, the cross-match to transfusion ratio of 1.010 that is reported in the current study indicates efficient blood usage.…”

Use of Maximum Surgical Order Schedule (MSBOS) among pediatric patients to optimize blood utilization

“…Blood banks face an everincreasing demand for blood and its components. It has been reported that only 30% of crossmatched blood is used in elective surgery [3]. In a report by Mwambungu et al in 2015, only 64% of crossmatched blood was utilized [4].…”