Women who are admitted to a hospital in anticipation of a vaginal delivery frequently undergo blood typing and screening because of the remote risk that they may require a blood transfusion. Ransom and colleagues conducted a three-year retrospective review to evaluate the cost effectiveness of routine blood typing and screening in women admitted to the hospital for expected vaginal delivery.
Most of the patients included in the study were black (76 percent), and more than 50 percent were at high risk of poor obstetric outcome for medical or social reasons. Overall, 76 of the 16,291 women (0.46 percent) delivering vaginally received blood transfusions; the need for an urgent transfusion was 2.5 per 10,000 deliveries. All but four patients who were urgently transfused had at least one of four risk factors: anemia at admission, previous cesarean delivery, placental abruption or history of blood transfusion.
The authors estimate that limiting blood typing and screening on admission to women who have at least one risk factor for blood transfusion would reduce the number of tests by 70 percent. Such selective testing would have resulted in a savings for the hospital of approximately $600,000 during the three-year study period.
The authors advocate a selective policy of laboratory testing for potential blood transfusion in patients admitted for probable vaginal delivery. Eliminating routine type and screen testing nationwide could amount to a savings of $120 million per year. In the rare circumstance that an urgent blood transfusion is needed, O-negative blood could be given until a type and crossmatch determination is made. O-negative blood is available within 10 minutes at the study hospital, and matched blood is available in approximately 40 minutes. Because study results did not show that routine testing and screening provided any significant improvement in patient care, the authors call for its elimination from clinical pathways for patients with no risk factors.