Blood audit evidenced-based cross-match requesting for lumbar spine surgery

Abstract

<h4>Study design</h4>Complete audit cycle.<h4>Objective</h4>Radical overhaul of the blood ordering practices made by the spinal surgery department, in order to maximize the efficient use of blood products.<h4>Summary of background data</h4>Spinal surgeons request blood-based on historical practice and not evidence. Blood is a scarce resource. Provision relies on voluntary donations from the general population. However, the donor population has been reduced because of the risks of variant Creutzfeldt-Jakob disease. Hence, the responsibility rests with clinicians to optimize their management of blood.<h4>Methods</h4>The spinal surgery department database was accessed to identify all patients who underwent elective lumbar spine operations (excluding deformity) during 2002 to 2003. These records were then cross-referenced with the blood transfusion department database. From the results the cross-match to transfusion (C:T) ratios and transfusion indexes (TI) were calculated for the procedures. A new tariff was agreed between the surgeons, anesthetists, and transfusion department. This was then audited prospectively.<h4>Results</h4>There were 664 cross-match requests made during 2002 to 2003, and only 40 U was transfused. This gave a C:T ratio of 16.6:1. The prospective audit resulted in only 58 U being cross-matched and 5 were transfused. This reduced the C:T ratio to 11.5:1.<h4>Conclusion</h4>Implementing evidence based cross-match protocols can make significant savings in time, manpower, and money.