Person:

Churchill, W.

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.