Systematic Criteria for Type and Screen Based on Procedure's Probability of Erythrocyte Transfusion

Department of Anesthesia, University of Iowa, Iowa City, Iowa 52242, USA.
Anesthesiology (Impact Factor: 5.88). 02/2012; 116(4):768-78. DOI: 10.1097/ALN.0b013e31824a88f5
Source: PubMed


At many hospitals, the type and screen decision is guided by the hospital's maximum surgical blood order schedule, a document that includes for each scheduled (elective) surgical procedure a recommendation of whether a preoperative type and screen be performed. There is substantial heterogeneity in the scientific literature for how that decision should be made.
Anesthesia information management system data were retrieved from the 160,207 scheduled noncardiac cases in adults of 1,253 procedures at a hospital.
Neither assuming a Poisson distribution of mean erythrocyte units transfused, nor grouping rare procedures into larger groups based on their anesthesia Current Procedural Terminology code, was reliable. In contrast, procedures could be defined to have minimal estimated blood loss (less than 50 ml) based on low incidence of transfusion and low incidence of the hemoglobin being checked preoperatively. Among these procedures, when the lower 95% confidence limit for erythrocyte transfusion was less than 5%, type and screen was shown to be unnecessary. The method was useful based on including multiple differences from the hospital's maximum surgical blood order schedule and clinicians' test ordering (greater than or equal to 29% fewer type and screen). Results were the same with a Bayesian random effects model.
We validated a method to determine procedures on the maximum surgical blood order schedule for which type and screen was not indicated using the estimated blood losses and incidences of transfusion.

1 Follower
19 Reads
  • Source
    • "A review of blood ordering habits and blood utilization statistics in audit studies can help in improving these services and initiate measures to regulate blood ordering and utilization. However, a strong institutional commitment is required for implementation of new policies, albeit the advantages to this approach have been noted [3] [5] [6]. This policy has not attained a certain place in Iranian hospitals and blood banks in almost all hospitals in our country are still using the cross-matched and booking blood test before use. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Background. Blood transfusion is the cornerstone of therapy for many serious and common diseases. This study was performed to assess blood transfusion practice before and after implementation of type and screen protocol in emergency department of a university affiliated hospital in Iran, 2012-2013. Methods. An audit was studied before and after the implementation of type and screen protocol. The number of blood transfusions, time interval between blood order and transfusion, cross-match to transfusion ratio (C/T ratio), and transfusion index (TI) were checked. C/T ratio was used as a measure of the efficiency of blood ordering practice. We compared our results before and after implementation of type and screen protocol. Results. In present study after implementation of type and screen protocol, the time interval between requesting blood transfusion and transfusion of blood has decreased significantly (P < 0.001). The number of blood transfusions required by actual patients increased significantly from 1/2 to 2 (P < 0.001). The average cross-match to transfusion (C/T) ratio got near 1.13 from 1.41 and TI got near 0.91 from 0.58 (P < 0.001). Conclusion. The implementation of T&S protocol has been proven to be safe, efficient, and beneficial to the transfusion practice of our hospital from the current study.
    International Journal of Emergency Medicine 09/2014; 2014. DOI:10.1155/2014/316463
  • Anesthesiology 02/2012; 116(4):749-50. DOI:10.1097/ALN.0b013e31824a8a53 · 5.88 Impact Factor
  • Source
Show more