Is the use of C/T ratios appropriate for monitoring blood use management in surgical services dept.? I can understand it for inpatients and other departments (dialysis, etc.), but not so for OR...please weigh-in.

Peer review for like procedures is more relevant than C/T ratios. If Dr. X is using twice as much blood as surgeons in the same facility and facilities elsewhere for the same procedure, he/she is using too much blood. Not that we are currently doing this, but our new pathologist is interested in the idea.

See if there are any ways you can streamline your processes in the Blood Bank to not have so many set up for OR. We changed our SSBOS requirements; almost all procedures now get only a Type and Screen. Since we do electronic crossmatches now, we only crossmatch units ahead for patients with antibodies.

About 10 years ago (after we had implemented the electronic crossmatch), we stopped crossmatching blood for the purpose of anticipated transfusion. Excepting for patients with antibody, we only crossmatch blood on receipt of a request to issue blood for transfusion (regardless of patient's location in the facility). Electronic crossmatch was part of the blood issue process. All blood components were delivered to patient's location via pneumatic tube or dumbwaiter to surgery.

Edited June 7, 201411 yr by Dansket

We still evaluate the CT ratio on our surgeons.  Only rarely does this exceed 2.0.  As a group they average 1.3-1.5 though every once in a while there will be an outlier.  We did have an ortho guy who transfused excessively (hgb<10).  We harangued him with artilces and peer review and he now is in compliance both in house and national usage stats.

We calculate C/T for all our users three monthly and review for adherence to MSBOS.

 

Medical is always close to 1.0. Surgical in range 1.2 to 1.5. Sometimes this is pushed up to 1.5 mark by returns to theatre with abdo surgeries - they tend to order more as they don't know what they will find on opening. The consultants all know we review it. Any outliers for no good reason are chatted to by the consultant Haematologist.  

Cheers

Eoin