Smallwood J A
Br Med J (Clin Res Ed). 1983 Mar 12;286(6368):868-70. doi: 10.1136/bmj.286.6368.868.
A prospective audit of the blood bank was carried out in Portsmouth to examine how efficiently blood was used in elective general surgery. The routine crossmatching of blood was found to be unnecessary for certain procedures such as cholecystectomy, thyroidectomy, mastectomy, and vagotomy. The most efficient use of blood was seen in vascular surgery despite the greater risk of severe haemorrhage. Completed detailed questionnaires returned by members of surgical teams in Wessex supported the Portsmouth data as being fairly typical and confirmed that substantial and unintentional overordering occurred, apparently due to poor communication, lack of discussion, and "force of habit." The place of a "half hour crossmatch" as a substitute for many routine orders has been explored and seems to be acceptable to most anaesthetists and surgeons. This study, by showing how inefficiently blood is used, has underlined the value of local audit. It also supports the general experience of centres throughout the world who have invoked similar methods and achieved considerable savings without harm to patients.
在朴茨茅斯对血库进行了一项前瞻性审计，以检查择期普通外科手术中血液的使用效率。结果发现，对于某些手术，如胆囊切除术、甲状腺切除术、乳房切除术和迷走神经切断术，常规交叉配血是不必要的。尽管血管手术中严重出血的风险更大，但血液的使用效率在该科室最高。韦塞克斯外科团队成员返回的完整详细问卷支持朴茨茅斯的数据具有相当的代表性，并证实存在大量无意的过量用血情况，这显然是由于沟通不畅、缺乏讨论和“习惯势力”所致。已经探讨了用“半小时交叉配血”替代许多常规用血申请的做法，大多数麻醉师和外科医生似乎都可以接受。这项研究通过展示血液使用的低效性，凸显了局部审计的价值。它还支持了世界各地采用类似方法并在不损害患者的情况下实现大量节约的中心的普遍经验。
