Background: Cross-matched blood reservation without transfusion leads to a costly waste of resources. A prior study from our institution demonstrated an inappropriate use of preoperative blood order with the blood cross-match to transfusion (C/T) ratio of 4.79 (887/185 units). Since August 1, 2006 a blood order guideline for preoperative blood reservation has been developed in our institution by using C/T ratio, transfusion probability (%T), and transfusion index (TI).

Objective: To determine the efficiency of blood ordering in elective surgery before and after implementation of a blood order guideline.

Materials and methods: A retrospective study using a prospective maintained database and medical record review was conducted. The clinical characteristics, C/T ratio, %T, and TI were compared between the patient who underwent various elective surgical operations before and after implementation of a blood order guideline (January 1, 2006 - June 31, 2006 and August 1, 2006 - January 31, 2007). C/T ratio is used as a measure of the efficiency of blood ordering practice. It should ideally be decreased of C/T ratio after implementation of a blood order guideline.

Results: Data was analyzed for 20 elective surgical procedures in 913 patients. Four hundred and thirty patients undergoing operation after implementation of a blood order guideline which was during the period of August 1, 2006 through January 31, 2007, were the guideline group. Eighty seven percent of the blood orders were conformed to the blood order guideline. There were no statistical differences between pre-guideline group and guideline group in clinical characteristics. The mean C/T ratio of the guideline group was 2.6 which was lower than the pre-guideline group (3.6). %T of the guideline group was 52.3 which was higher than the pre-guideline group (36.8). TI of the guideline group was 1.1 which was higher than the preguideline group (0.8).

Conclusions: A blood order guideline for elective surgeries may facilitate effective use of preoperative blood reservation. Continual guideline monitoring and periodic evaluation is encouraged.