Title : Donnot take blood in vain - A regional audit of general surgical procedures in accordance with the Maximum Surgical Blood Order Schedule (MSBOS)
Abstract:
Aim: To audit the rate of post-operative transfusion needs in three general surgical operations at Croydon University Hospital, evaluate the uptake of change in MSBOS guidance and identify its potential in reducing the burden on transfusion laboratory burden and cost.
Method: Retrospective audit of inguinal and umbilical hernia repairs (7 months), partial/total thyroidectomies (4 months), elective appendicectomies (2 months) and emergency appendectomies (1 year) was undertaken to review their respective pre-operative G&S sample taking practice, intraoperative blood loss and rate of intra-operative and post-operative transfusions. The analysed data was presented at the local surgical clinical governance meeting. The MSBOS guideline was updated to eliminate unnecessary pre-operative G&S sampling and the cases 5 months post-intervention were audited to review the uptake of the guidance.
Results: A total of 684 cases were reviewed in this study. Of the elective inguinal and umbilical hernia repair cases (n = 251), 91% had G&S samples and 0 patients had any transfusion requirements intra-operatively or post-operatively. Post intervention (n=50), 18% of the cases had G&S samples and 0 patients required any blood transfusions. For elective partial and total thyroidectomy procedures, pre-intervention (n=50) 20% of patients had G&S samples, compared to 5% post-intervention (n=50) with 0 patients required any blood transfusions pre- and post-intervention. Pre-intervention 63% of appendicectomy cases (n=250) had G&S samples with 1 post-operative blood transfusion and 0 intra-operative transfusions. 55% of post intervention appendectomy cases (n=33) had G&S samples and 0 patients required any intra-operative or post-operative blood transfusions. Overall the intervention achieved a percentage reduction in pre-operative G&S sampling in inguinal and umbilical hernia repairs (73.2%), partial/total thyroidectomies (15%), and appendicectomies (8%).
Conclusions: Auditing local MSBOS guidance can provide insight to the surgical department’s pre-operative practices regarding blood transfusion requirements. Regular updating of the guidelines can provide significant reduction in unnecessary tests and cost in the long term.
Audience Take Away Notes:
The audit aims to increase awareness of the MSBOS guidance to reduce unnecessary group and save blood sampling as a part of a routine pre-operative assessment
Appreciate the cost and time savings associated with cross matching patients as required rather than routine pre-operative group and screening. This will understandably increase demand on O-negative blood and therefore requires having a sufficient reserve supply of blood
