Palmer R H, Kane J G, Churchill W H, Goldman L, Komaroff A L
JAMA. 1986 Jul 11;256(2):219-23.
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.
为降低成本、保存血液供应并提高紧急情况下用血的安全性，一家教学医院的妇产科和血库建议，对所有进行正常分娩或剖宫产的患者进行血型鉴定和筛查，以取代对部分患者进行的产前交叉配血。通过一个自动化数据系统发现，这两组患者的交叉配血医嘱立即减少了75%和50%，在为期一年的随访期内持续有效，并且这种减少还扩展到了接受子宫切除术的患者。然而，增加血型鉴定和筛查的使用成本超过了交叉配血成本的降低：实际年度成本增加了11151美元。我们得出结论，如果有影响力的临床医生倡导一项具体且合理的政策，检验医嘱的做法可以非常容易地改变。然而，检验使用的变化可能会导致意想不到的成本增加。只有对实践模式进行详细研究，才能揭示特定机构的成本后果。
