Type and screen: a safe and effective preoperative blood ordering policy with emphasis on its use in obstetrics and gynecology.

In September, 1979, the Transfusion Committee at the University of Texas Medical Branch in Galveston implemented a preoperative blood ordering policy of type and screen (TS) for selected surgical procedures. During the first year in which this policy was in force, 2,301 TS requests were received, most of them for patients in the Department of Obstetrics and Gynecology. During this time, requests for cross matching declined by 12% (28,863 to 25,283) despite a 3% increase in packed red blood cell and whole blood transfusions (11,282 to 11,629). The cross match/transfusion ratio fell from 2.55 to 2.17, and outdating of blood dropped 42% (446 to 260). In the 20 months since this policy was introduced, 4,334 TS requests have been processed. Of these, 211 were changed to cross matching by the patient's physician, but only 100 patients (2.3%) actually received transfusions. No untoward reactions were observed by transfusing blood before the results of the cross matching were known. We estimate a savings to patients of $164, 920, and conclude that TS is safe and effective.