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October 14, 2014
8:00 AM - 10:00 AM
Room Hall B1-Area B
Reducing Unnecessary Preoperative Blood Orders and Costs by Implementing an Institution-specific Maximum Surgical Blood Order Schedule (MSBOS)
Jack O. Wasey, B.M., B.Ch., Aileen L. Pan, M.D., Michael J. Oleyar, D.O., Paul M. Ness, M.D., Aaron A. Tobian, M.D., Steven M. Frank, M.D.
The Johns Hopkins Medical Institutions, Baltimore, Maryland, United States
Background: With new models of patient care such as "Choosing Wisely" and the "Perioperative Surgical Home", there is a strong emphasis for cost reduction by eliminating unnecessary testing and procedures. Having recently developed an updated institution-specific maximum surgical blood order schedule (MSBOS) derived from anesthesia information management system (AIMS)-acquired blood utilization data, we hypothesized that implementation of the MSBOS would reduce unnecessary preoperative blood orders and reduce costs.

Methods: At a large academic medical center, AIMS-acquired data for preoperative blood orders were analyzed for 63,916 surgical patients over a 34-month period (January 2011 - October 2013). The new MSBOS was introduced in July, 2012, and the pre-MSBOS and post-MSBOS data were compared to assess the reduction in unnecessary orders, as well as the associated reduction in costs. Data were obtained from our anesthesia information management system (AIMS) (Metavision, iMDsoft, Needham, MA), and also from a web-based blood management intelligence portal (IMPACT Online, Haemonetics Corp.). Cost data were obtained from the hospital's billing database.

Results: For patients undergoing surgical procedures that were deemed to not require a type and screen (T/S) or type and crossmatch (T/C), there was a 38% decrease in the percentage of procedures with preoperative blood orders (40.4% to 25.0%, P<0.001) (Figure 1A). For all hospitalized inpatients, the crossmatch to transfusion ratio decreased by 27% (2.11 to 1.54; P<0.001) over the same time period (Figure 1C). The proportion of patients requiring emergency release type-O blood increased from 2.2 to 3.1 per 1,000 transfused patients (P=0.03) after implementation of MSBOS, however, the majority of these patients were those having emergency surgery. The annual cost reduction by reducing blood orders for surgical patients was $137,223, and for all hospitalized patients was $298,966 (Figure 2).

Conclusions: Implementing institution-specific, updated MSBOS-directed preoperative blood ordering guidelines results in a substantial reduction in unnecessary orders and costs, with a clinically insignificant increase in requirement for emergency release blood transfusions.
Figure 1

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