Necessity of Routine Type and Screen for Elective Pre-operative Hip and Knee Arthroplasty Surgical Patients
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Document Type
Presentation
Department
Nursing
Abstract
In this post pandemic period, nurses are focused on improving patient care and streamlining their delivery of care processes to prevent redundancies and optimize the use of limited resources to meet daily patient care goals. They increasingly rely on evidence based practices to inform their care decisions. In surgical services, nurses found that there is insufficient evidence to support the routine performance of pre-operative type and screen (T&S) testing for patients undergoing Total Hip Arthroplasty (THA) or Total Knee Arthroplasty (TKA). Consequently, we proposed conducting a retrospective chart review on all elective THA and TKA cases from January 1, 2024 through December 31, 2024.
How many patients underwent THA and TKA at Clifton Springs Hospital and did not require blood transfusions during or after their surgical procedure, regardless of their Hemoglobin (Hgb) levels? Additionally, routine blood draws can diminish patient satisfaction and add financial burdens to both patients and healthcare facilities. According to Lisa Dorrell from Revenue Integrity at Rochester Regional Health, the estimated cost associated with T&S blood draws are as follows: Collection of venous blood through venipuncture - $30.94, ABO blood typing - $337.05, RH(D) typing - $337.05, antibody screen - $337.05, for a total of $1042.09 per T&S blood draw per patient.
Due to the aging population, and the increased safety of these surgical procedures, there is a higher volume of patients having joint surgeries, leading to an increase in pre-operative testing. Each patient scheduled for surgery must have preoperative blood tests drawn within 30 days of their procedure date. Furthermore, a T&S must be completed within 14 days prior to surgery. If a type and screen was done 30 days earlier, the provider might require a new T&S to be drawn, effectively doubling the cost for the patient.
Surgeons are encouraged to follow the Maximum Surgical Blood Ordering Schedule² (MSBOS), which specifies the number of units of blood needed to meet the needs of 90% of patients undergoing a specific surgical procedure. The Rochester Regional Health (RRH) MSBOS Consensus (2018), adhered to by RRH surgeons, recommends T&S testing for all elective pre-operative THA and TKA patients, which is commonly ordered during pre-operative testing before surgery. According to the RRH Blood Products Policy & Procedure¹, stable, asymptomatic non-bleeding patients do not generally benefit from red blood cell transfusions when their hemoglobin is greater than 7g/dL. Acute cardiac patients may require transfusions when hemoglobin is below 8g/dL, while patients with hemoglobin levels above 9g/dl rarely need transfusions.
Is it feasible to eliminate the routine T&S of our preoperative THA and TKA patients and instead adopt a more selective approach to testing without compromising the quality of care provided to our patients?
Publication Date
11-14-2025
Recommended Citation
Ayers, Lynn and Balschmiter, Abigail, "Necessity of Routine Type and Screen for Elective Pre-operative Hip and Knee Arthroplasty Surgical Patients" (2025). Nursing Research and EBP Day 2025. 16.
https://scholar.rochesterregional.org/nursingresearchday_2025/16
Comments
Lynn C. Ayers, MS, RN, ACCNS-AG, CCRN, GERO-BC; Abigail Balschmiter, BSN, RN, CAPA, PCCN