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Data, Algorithm Can Eliminate Needless Blood Orders

Data from new electronic anesthesia information management systems (AIMS) can be used to assess surgical procedure- and institution-specific blood requirements, according to a study from the June issue of Anesthesiology. This novel, customized approach can help health care providers decide whether blood should be ordered prior to surgery to potentially reduce costs, improve patient safety, and conserve precious resources.

“It can be difficult to determine whether to order blood preoperatively for many surgical procedures,” says study author Steven M. Frank, MD, an associate professor in the department of anesthesiology and critical care medicine at Johns Hopkins Medical Institutions. “We hope our study can contribute to cost savings by avoiding unnecessary blood ordering. In addition, our algorithm should increase patient safety by reducing the chances that blood orders are not overlooked for patients who are likely to need a transfusion.”

In the 1970s, the concept of the maximum surgical blood order schedule (MSBOS) system was created, which provided medical professionals with guidelines to determine preoperative blood orders for specific surgical procedures. However, since many new surgical procedures, such as endovascular, laparoscopic, and robotic approaches, have been introduced and improved, the older versions of the MSBOS are now outdated.

Researchers from Johns Hopkins Medical Institutions in Baltimore, Maryland, collected data from 53,526 patients undergoing 1,632 different surgical procedures from an AIMS. They developed an algorithm to determine which procedures necessitate a blood order and how many units need to be ordered based on four parameters: the percent of patients transfused, the estimated median blood loss, the transfusion rate, and the risk of major bleeding.

Findings revealed a substantial number of preoperative blood orders were unnecessary. Among the 27,825 surgical cases that did not require preoperative blood orders as determined by MSBOS, 32.7% had a “type and screen,” which includes testing for blood type and antibodies, and 9.5% had a “crossmatch” ordered, which includes the preparation of blood to be transfused.

The new algorithm to eliminate needless blood orders would have reduced hospital charges and actual costs by $211,448 and $43,235 per year, respectively, or by $8.89 and $1.81 per surgical patient, respectively.

An accompanying editorial remarked favorably on the study’s ability to demonstrate a novel, objective, and applicable method to help better predict which patients will require blood transfusion and how many units will be needed.

“Blood is expensive and unnecessary blood orders can be a financial burden,” says editorial author Alparslan Turan, MD, an associate professor in the department of outcomes research at Cleveland Clinic in Cleveland, Ohio. “With this innovative algorithm, avoidable blood orders will be reduced and money will be saved without compromising anesthesiologists’ top priority: patient safety.”

Source: American Society of Anesthesiologists