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Are changes in admission practices for elective surgery posing a transfusion threat to patients?

Summary There is an increasing emphasis on reducing in‐patient hospital stay for elective surgical procedures. As a result, pre‐operative stay has shortened, with less time available for performing baseline investigations before surgery, including those required to ensure a supply of safe, compatible blood. We have estimated the frequency of failure to complete ‘group and screen’ (G&S) testing before surgery where indicated, so that neither group‐compatible blood nor crossmatched blood could be provided promptly if an unexpected haemorrhage occurs. Retrospective data were obtained from elective surgical procedures performed over a 3‐week period. Of the 309 procedures performed, 21 patients were exposed to the risk of failure to provide appropriately matched blood had an emergency arisen. (In 20, a G&S was required; in one, a crossmatch was required.) Late samples and lack of information on the request form regarding the date and time of surgery were the main causes. Procedures requiring G&S only as opposed to crossmatch posed the greatest risk. Urgent measures are needed to ensure that, where indicated, a pre‐operative G&S result is available before surgery begins. Educating colleagues, redesigning request forms and improving out‐of‐hour laboratory services and hospital information systems are the main steps needed to reduce this latent risk.