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R. Heather Palmer, MB, BCh; J. Gregory Kane, MD; W. Hallowell Churchill, MD; Lee Goldman, MD; Anthony L. Komaroff, MD

JAMA. 1986;256(2):219-223.

Abstract
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 predelivery cross-match 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.

(JAMA 1986;256:219-223)

Author Affiliations
From the Institute for Health Research, a Joint Program of Harvard Community Health Plan and Harvard University, and the Department of Health Policy and Management, Harvard School of Public Health, Boston (Dr Palmer); and the Department of Obstetrics and Gynecology (Dr Kane) and the Divisions of Hematology (Dr Churchill) and General Medicine (Drs Goldman and Komaroff), Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston. Dr Goldman is a Henry J. Kaiser Family Foundation Faculty Scholar in General Internal Medicine.

Footnotes
Reprint requests to Harvard School of Public Health, 677 Huntington Ave, Boston, MA 02115 (Dr Palmer).

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