Cost and quality in the use of blood bank services for normal deliveries, cesarean sections, and hysterectomies
R. H. Palmer, J. G. Kane, W. H. Churchill, L. Goldman and A. L. Komaroff
To reduce costs, preserve blood supplies, and enhance the safety of blood
use during emergencies, the Department of Obstetrics and Gynecology and the
blood bank at a teaching hospital recommended replacing pre-delivery
crossmatch on selected patients with typing and screening for all patients
undergoing normal or cesarean section delivery. Using an automated data
system, it was shown that 75% and 50% reductions in the ordering of
crossmatching for these two groups of patients promptly resulted, endured
over a one-year follow-up period, and also spread to include patients
undergoing hysterectomy. However, the cost of the increased use of typing
and screening outweighed the reduced cost of crossmatching: actual annual
costs increased by $11 151. We conclude that test-ordering practices can be
changed surprisingly easily if a specific and reasonable policy is
advocated by influential clinicians. However, changes in test use can cause
unexpected cost increases. Only detailed study of practice patterns can
reveal cost consequences for a specific institution.