Less Blood Testing for Some Surgeries Safe, Cost Effective

Cheryl Clark, for HealthLeaders Media , May 23, 2013

Half of the hospitals in the United States still do their anesthesia records on paper, he notes.

At Johns Hopkins, it wasn't that much of a surprise that blood was ordered but rarely used for thyroid surgeries. But the data on transfusion frequency for other types of procedures revealed unexpected information. For example, surgeries involving the breast, such as lumpectomy or mastectomy, require a transfusion in only one per 1,000 cases.

Frank, whose paper in March documented how blood units that stay in inventory between 21 and the maximum shelf life of 42 days is less viable and may be unsafe compared to blood used in the first three weeks, says there's another cost of ordering units of blood that aren't needed his paper didn't include. And that's inefficiency of moving units of blood in and out of inventory.

"Let's say units of blood are taken out of inventory today for 24 hours (for testing for use in a patient) but not used, then two days later, and then two days after that. That blood is aging on the shelf, set aside and when it finally does get used, it's been stored for more than three weeks. We think by then the quality of red cells is decreased," because they lose the ability to deliver oxygen.

Frank says it's not just avoiding unnecessary ordering of blood typing and crossing that the Johns Hopkins algorithm might help, but also in making sure that enough blood is ordered when it should be, and not overlooked—an important patient safety issue, he says.

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