Implementation of Maximum Surgical Blood Ordering Schedule and an Improvement in Transfusion Practices of Surgeons subsequent to Intervention.

Over ordering of blood is a common practice for elective surgeries in many developing countries. Over a decade back, our institution-The Aga Khan University, Pakistan noticed that surgeons were making unnecessary arrangement of red cells. This was reflected in their undesirably high cross-matched to transfusion (CT) ratios. A clinical audit conducted in 1998-2000 confirmed this. This prompted the institution for designing a maximum surgical blood ordering schedule (MSBOS) in 2000 based on the retrospective usage of blood in various elective surgeries. This study aimed at observing the impact of implementation of MSBOS on surgeons' transfusion practices by comparing pre and post intervention cross-matched to transfused ratio in selected elective surgeries. For this purpose, we conducted a clinical audit from 2009 to 2010 and data was retrieved for quantity of red cells units arranged and transfused in the peri-operative period. C:T ratio was computed and compared with those in 2000. Identification of patients and physicians were kept confidential. Baseline C:T ratios for C-section, TURP, total knee replacement, laparoscopic cholecystectomy and CABG were 32, 22, 11.42, 23 and 4.77 respectively. In 2009-2010, red cells were transfused in 86 of 1,224 C-sections (7 %), 599 of 727 CABG (82 %), 10 of 324 TURP (3 %),16 of 890 laparoscopic cholecystectomy (1.7 %) and 14 of 85 total knee replacement (16.4 %) The C:T ratio in these surgeries was between 0 and 1. Implementation of MSBOS and efforts of BUC showed a significant impact in transfusion practices of surgeons with marked reduction in the utilization of blood and the C:T ratio. We recommend that regular audits should be conducted in every institution to improve the quality of services, encourage team work and ensure high standards.