Maximum Surgical Blood Order Schedule Research Articles

Challenges in reliable preoperative blood ordering: A qualitative interview study.

Presurgical blood orders are important for patient safety during surgery, but excess orders can be costly to patients and the healthcare system. We aimed to assess clinician perceptions on the presurgical blood ordering process and perceived barriers to reliable decision-making. This descriptive qualitative study was conducted at a single large academic medical center. Semi-structured interviews were conducted with surgeons, anesthesiologists, nurse anesthetists, nurse practitioners working in preoperative assessment clinics, and transfusion medicine physicians to assess perceptions of current blood ordering processes. Interview responses were analyzed using an inductive open coding approach followed by thematic analysis. Twenty-three clinicians were interviewed. Clinicians felt that the current blood ordering process was frequently inconsistent. One contributor was a lack of information on surgical transfusion risk, related to lack of experience in ordering clinicians, insufficient communication between stakeholders, high turnover in academic settings, and lack of awareness of the maximum surgical blood ordering schedule. Other contributors included differing opinions about the benefits and harms of over- and under-preparing blood products, leading to variation in transfusion risk thresholds between clinicians, and disagreement about the safety of emergency-release blood. Several barriers to reliable decision-making for presurgical blood orders exist. Future efforts to improve ordering consistency may benefit from improved information sharing between stakeholders and education on safe transfusion practices.

Maximum surgical blood order schedule: A key component of perioperative blood management in neurosurgery

Abstract: CONTEXT: Institute specific protocols are needed to reduce unnecessary cross matches. Type and screen policies for surgical procedures which does not require blood and maximum surgical blood order schedule (MSBOS) for procedures which require blood units are the two protocols in use currently. AIM: To compare the effect of maximum surgical blood order schedule in neurosurgery between pre- and post-implementation. SETTINGS AND DESIGN: It is a study of 5 years’ duration (4 years retrospective and 1 year prospective) conducted at the departments of transfusion medicine, neurosurgery and neuroanesthesia. SUBJECTS AND METHODS: The patients above 18 years for whom blood requisition were sent were included, whereas those who underwent emergency procedures, massive transfusion, or had underlying bleeding disorders were excluded. The MSBOS was developed based on 4 years’ retrospective data and the new protocol was followed for 1 year. The transfusion indices were compared between preimplementation and postimplementation. RESULTS: A total of 2462 patients were included in the retrospective period, whereas it was 746 in the prospective group. Overall, reduction of crossmatch to transfused ratio from 3.6 to 2.4 and increase of blood utilization from 27.40% to 41.55% was observed. The patients for whom type and screen were performed increased from 18% in the retrospective period to 75% in the prospective period. Eighteen out of 30 common procedures were managed with T and S and seven of them did not require even a single unit of red blood cells intraoperatively. CONCLUSIONS: Our study highlights the importance of including both diagnosis and procedure to formulate MSBOS and the use of modified formulas “transfusion index for type and screen and transfusion probability for type and screen” for revision of MSBOS.

Maximum surgical blood ordering schedule for elective surgical procedures in Omdurman teaching hospital, Sudan

BackgroundThe need for blood during a surgical procedure is greater than what blood banks are able to provide. There is an excessive amount of blood being ordered for elective surgeries, surpassing the actual requirements. Only 30% of the cross matched blood is actually used in these surgeries. The accuracy of estimating the transfusion needs before a surgical procedure can be determined by looking at the cross match to transfusion ratio and the transfusion index. “These indicators play a crucial role in developing the maximum surgical blood ordering schedule; in this study, these indicators were tested.”Aim of studyIs to determine the efficiency of blood ordering and transfusion practices for patients undergoing elective surgeries.MethodsThis study is a prospective cross-sectional hospital-based study done at Omdurman Teaching Hospital-Sudan. Conducted for the duration of 6 months period from July to December 2019.The study participants were patients who underwent elective surgical procedures in general surgery and Urology departments as total coverage sample over a period of study duration. Ethical clearance obtained from ethical committee of Sudan Medical Specialization Board.ResultsTwo hundreds seven patients included in this study, the amount of blood units requested were 443-unit, cross matching for 98.6% (n 437) of units were done. Only 100 unit were Transfused (22,8%). The calculated CT ratio was 4.4, transfusion index was 1.6 and transfusion probability was 29.9%.ConclusionTransfusion probability and transfusion index of the present study were optimal but comparatively higher than the standard guidelines as most of the cross matched blood was not utilized.

Efficacy of Blood Utilization in Elective Surgery for Non-COVID Patients during COVID-19 Outbreaks

Objective: This study aimed to evaluate the pattern of blood transfusion requests and utilization in non-coronavirus disease (COVID) patients having undergone elective surgeries during the COVID-19 pandemic. Material and Methods: The pattern of blood transfusion requests and utilization for elective surgical procedures in six departments of a University Hospital; between January 2020 and December 2021, were retrospectively evaluated. The cross-match-to transfusion (C/T) ratio, transfusion probability (%T), transfusion index (Ti), and maximum surgical blood order schedule (MSBOS) were calculated. Results: A total of 15,030 patients underwent elective surgery. Among the 14,426 units of blood requested, 12,776 (89%) units were cross-matched preoperatively for 5,799 (39%) patients, and an additional 1,650 (11%) units were requested for 394 (2.6%) patients intraoperatively. Among these, 4,588 (32%) units were transfused to 1,710 (11.4%) patients. The overall C/T ratio, %T, and Ti were 2.78, 29.5%, and 0.79, respectively. Blood utilization indices for each department varied substantially according to the type of surgery, with blood utilization indices being unfavorable for 68 (80%) of the 85 procedures. The MSBOS was 0 for 32 procedures. Conclusion: Over-ordering of blood units for elective surgical procedures remained common during the COVID-19 pandemic. The blood utilization indices showed substantial variations according to the type of surgical procedures. The MSBOS has been formulated to assist in future decision-making.

Maximum Surgical Blood Ordering Schedule in Common Pediatric Cardiac Surgeries in a Tertiary Center.

Unnecessary pre-operative ordering of red blood cells (RBCs) in elective surgeries increases costs and waste of blood inventory. Maximum surgical blood order schedule (MSBOS) is a helpful strategy in the estimation of blood units needed for surgery and the prevention of overconsumption. In this study, an MSBOS for pediatric cardiac surgeries is designed. In this cross-sectional study, we included all pediatric patients who underwent elective cardiac surgery in Children's Medical Center in Tehran, Iran, from March 21, 2019, to September 22, 2019. Data consisted of the type of surgery and the number of blood units transfused and units cross-matched, based on which cross-match to transfusion ratio (CTR), the transfusion index (TI), and transfusion probability (T%) were calculated. Overall 205 pediatric patients were included in the study. Four hundred and ten RBCs units were cross-matched, and 262 were transfused. The overall results of the CTR, T%, and TI for all the eight types of cardiac surgery were 1.56 (410/262), 76% (157/205), and 1.28 (262/205), respectively. The raw MSBOS for cardiac surgeries included ventricular septal defect, tetralogy of fallot, dextro-transposition of the great arteries, atrial septal defect, aortic coarctation, patent ductus arteriosus, pulmonary stenosis, and pacemaker insertion, which were 1.58, 1.03, 1.54, 1.66, 0.77, 0, 1.25, and 0 unit, respectively, and the figures were rounded up. Accurate MSBOS protocols reduce cross-match workload in laboratories, lead to the appropriate use of blood stocks with less wastage, save human and economic resources, and eventually, promote patient safety.

Monitoring Blood Transfusion Policies and Implementation of Maximum Surgical Blood Ordering Schedule

Background and Objectives: The procedure of blood ordering is a major issue in hospitals. Hence, maximum surgical blood ordering schedule is recommended to manage the blood application process properly. The aim of this study was to evaluate the demand and rate of blood consumption in different wards of a pediatric hospital. Methods: This is a cross-sectional on patients ≤18 years old who underwent major surgical procedures from 2015 to 2019. Data included type of department, number of total blood bags requested as well as cross-matched and transfused units. Furthermore, indices such as cross-matched to transfusion (Cross-matched to Transfused (C/T) ratio) in various hospital departments and months were calculated. Results: This study revealed that the utilization rate was 77.29% of blood units among a total of 97356 cases done. The emergency department consumed only 28.08% of its requests. C/T ratio for all departments of the hospital was 1.34. The most and lowest numbers of requests were for surgery 2 department and newborn intensive care unit, respectively. Furthermore, we have observed the lowest rate of C/T ratio in December. Conclusions: Our data showed that in the majority of elective pediatric surgical procedures, a large number of blood units tested for antibody screening were consumed, reducing the consumption of cord blood bags as well as the financial burden for the hospital and the patients. Furthermore, our findings revealed that based on the calculated C/T ratio, the hospital used the correct procedure for blood requests in period of 1 year. In addition, the time for preparation of blood was decreased dramatically.

Hemodynamic monitoring in liver Transplantation patients in the third millennium

In patients undergoing orthotopic liver transplantation (OLTx) surgery, the intraoperative hemodynamic monitoring technique that is most utilized is still the pulmonary artery catheter (PAC). The popularity of transesophageal echocardiography (TEE) is increasing, so today's updated issue is the following: should the use of PAC and/or volumetric monitoring with transpulmonary thermodilution and/or advanced volumetric PAC be limited in clinical practice, only for some high risk patients? Could we use the TEE, if necessary, in less critical ill patients undergoing OLTx surgery? We can integrate all of the aforementioned monitoring techniques in an increasing modular step wise monitoring concept. But in an uncertain hemodynamic situation, transthoracic and/or transoesophageal echocardiographic evaluation represents a cornerstone. The use of echocardiography during OLTx is more and more common with several benefits demonstrated particularly by the TEE in this patient population. To achieve and maintain adequate tissue perfusion becomes difficult in case of major bleeding, an event quite possible to occur during OLTx, affecting the immediate and the late outcome. All the clinicians agree that bleeding interfere with the choice of hemodynamic monitoring and or vice versa. A reasonable compromise is to find a balance between the need to extend monitoring in high-risk surgical patients and the average consumption of blood products that characterizes each individual transplant center. This is also in line with what is shown in literature in terms of Maximum Surgical Blood Ordering Schedule (MSBOS).

Maximum surgical blood order schedule in urology surgery

Aim: To improve patient blood management (PBM), a special system of collecting and testing blood units has been developed. It defines the maximum number of allogeneic red blood cell components necessary for certain surgical interventions. This system is referred to as "The Maximum Surgical Blood Order Schedule" (MSBOS). The aim of the study was to evaluate the rationality of red blood cell consumption during urological surgeries. Materials and Methods: During the course of one year, a retrospective study was conducted on 617 patients. The study included 185 women and 432 men, with a median age range of 60 years old (ranging from 45 to 75 years old). The consumption of red blood cell units was evaluated in relation to the primary indication and type of surgery, preoperative data on hemoglobin values, and coagulation tests. Results: The overall C:T ratio was 4.2, which corresponds to 24% of transfused units in relation to the number of cross-match tests performed. A statistically significant difference in the average related to the age was observed between the subjects in whom there was irrational (64.65±9.49 years) and those in whom there was a rational use of red blood cells. A statistically significant difference was also observed in the frequency of different primary diagnoses according to the International Diseases Classification) and in relation to the values of hemoglobin and prothrombin time (PT) between the group with rational and irrational use of red blood cells. Conclusion: The obtained data showed unreasonable use of RBC based on the C:T ratio and therefore the necessity of introducing of PBM system as well the necessity to revise the existing protocols for red blood cell demand according to indications and to improve patient preparation in order to minimize the use of allogeneic red blood cells.

Maximum surgical blood ordering schedule for common Orthopaedic surgical procedures at Birrd hospital (Tertiary orthopaedic hospital)

Maximum surgical blood ordering schedule for common Orthopaedic surgical procedures at Birrd hospital (Tertiary orthopaedic hospital)

Blood ordering and utilization in patients undergoing elective general surgery procedures in a tertiary care hospital: A prospective audit.

Background Blood ordering is commonly done for patients undergoing major elective surgery. Excessive order of the blood for elective surgery leads to wastage of resources, time and workforce. Auditing preoperative blood ordering decreases the cost of medical care by avoiding unnecessary cross-match without compromising patient safety. Methods For this hospital-based audit, we collected data prospectively from July 2017 to June 2018 regarding the transfusion and transfusion indices, namely cross-match-totransfusion ratio (C/T ratio), transfusion probability (T%), transfusion index (TI) and maximum surgical blood ordering schedule (MSBOS) for elective surgeries done in the Department of Surgery. Results A total of 1151 patients were included in the study. A total of 160 units of blood were issued of which only 138 were transfused to 116 patients. Seventy-one procedures were included in the study. The C/T ratio was less than 2.5 for 16 procedures, T% was >50% for 9 procedures and MSBOS was more than 0.5 for 16 procedures. Conclusion Cross-matching is overused for elective surgical procedures. Only 16 of the 71 procedures had an ideal C/T ratio. Group and screen policy can be adopted for most of the commonly performed procedures, and cross-matching of blood may not be needed.

Blood reservation and utilisation practice for Caesarean section in Ilorin, Nigeria.

Most blood units routinely cross-matched for patients undergoing Caesarean section (CS) in Nigeria are not used for transfusion. Over-ordering increases blood wastage, blood bank running costs, surgery costs and waiting times. A one-year review of all CS performed in the University of Ilorin Teaching Hospital (UITH), Nigeria, was thus conducted to evaluate blood reservation and utilisation practice. Efficiency of blood utilisation was evaluated using a cross-match to transfusion (C/T) ratio, transfusion probability (TP) and transfusion index (TI). The overall C/T ratio, TP and blood wastage were, respectively, 3.1, 24.6%, and 68%, indicative of inefficient blood utilisation. Establishing a Maximal Surgical Blood Order Schedule (MSBOS), which estimates the units of blood required for specific CS indications, is recommended to minimise blood over-ordering. Blood grouping alone should be done for patients at low risk for transfusion. For moderate risk patients, blood type and screen without cross-matching should be done, reserving cross-matching for high-risk patients.

Necessity for Regular Updates of the Maximum Surgical Blood Order Schedule (MSBOS)

Necessity for Regular Updates of the Maximum Surgical Blood Order Schedule (MSBOS)

Maximum surgical blood order schedule for flap reconstruction in oral and maxillofacial cancer patients

BackgroundWe established a MSBOS for flap reconstruction in oral and maxillofacial cancer patients.MethodWe enrolled 2080 cases of oral and maxillofacial flap reconstruction from January 1, 2010 to December 31, 2021. Patient data were collected, including age, sex, BMI, preoperative Hb levels, ASA grade, T stage, flap type, tumor location, and bone flap. Scoring criteria were established based on a multivariate model of independent risk variables and their odds ratios. Two flap-type groups were divided into low-risk, intermediate-risk and high-risk groups by the scoring criteria, and analyzed using univariate and multivariate logistic regression. Perioperative transfusion analysis identified independent risk factors at various Hb levels. The cumulative percentage of patients requiring perioperative blood transfusion for each surgical procedure was calculated to establish the MSBOS.Results(1) Regression analysis showed that BMI, tumor T staging, ASA grade, preoperative Hb level (male: Hb < 130 g/L, female: Hb < 120 g/L), and bone flap were independent risk factors for perioperative blood transfusion. (2) Regression analysis showed that independent risk factors for perioperative transfusion included the following: BMI, tumor T3–T4 stage, ASA III, IV grade, and free flap/pediculated flap/bone flap in patients with different Hb levels; T3–T4 stage, ASA grade III–IV in mildly anemic patients; and ASA grade III–IV in moderately anemic patients. (3) A MSBOS was established for flap reconstruction in head and neck cancer patients.ConclusionA MSBOS for head and neck cancer procedures was reduced by approximately 30% perioperative blood preparation while ensuring that clinical blood use standards were met. It help optimize blood inventory, and save blood resources.

A Study to Formulate Maximum Surgical Blood Order Schedule at a Tertiary Care Referral Teaching Institute in Andhra Pradesh

Background and Objectives: Blood transfusion is the mainstay of treatment for several serious illnesses, surgical, and trauma patients. The aim of this study is to develop maximum surgical blood order schedule (MSBOS) for surgeries in our institute to formulate certain guidelines to prevent the over-ordering of blood and promote reasonable ordering of blood. Patients and Methods: All the patients undergoing surgeries in General Surgery, Surgical Gastroenterology, surgical oncology, Cardiovascular and Thoracic Surgery, Neurosurgery, Urology, and Orthopedics Departments requesting blood were included in this study. Cross-match-to-transfusion (CT) ratios, transfusion probability (TP), and transfusion index (TI) were calculated for individual specialties and surgeries. Based on these parameters, MSBOS was formulated. Results: During the study period, a total of 2724 patients posted for elective surgical procedures necessitating blood among various surgical departments were included in the study. A total of 5812 units of packed red blood cells were requested and cross-matched for the study population. Among these, 1831 units were transfused with a blood utilization percentage of 31.50% (6%–60%). The overall CT ratio of our study was 4.21. The overall TP was 31.69% and the overall TI was 0.56. Conclusion: Implementation of MSBOS is helpful in achieving the goal of rational usage of blood. Based on the results, we grouped the surgical procedures which need type and screen, type and hold, and type and cross-match.

Blood use in elective surgical procedures in a “type A” base hospital

IntroductionBlood orders for surgical patients make up a considerable portion of total blood requests but the majority doesn’t lead to a transfusion. Routine crossmatching and reserving blood for all surgeries can be reduced by establishing a Maximum Surgical Blood Ordering Schedule [MSBOS]. We have analyzed blood utilization in Base Hospital Puttalam and formulated an MSBOS with this study. Material and methodsA total of 2145 surgeries from surgical and gynaecology &amp; obstetric units in the year 2019 was analyzed. Patients who underwent massive transfusions and patients having a pre-operative haemoglobin concentration less than 8.3g/dl or obtained a pre-operative transfusion were excluded considering transfusions to correct preoperative anaemia. The crossmatch to transfusion ratio [C: T], transfusion probability [T%] and transfusion index [TI] was calculated for each surgical procedure. The procedures having a C: T of &gt;3:1 was recommended for group and screen [G&amp;S]. ResultsOf a total of 2145 patients, 90% were females. A total of 1565 units were requested and 1521 units were crossmatched for 2034 patients while only 193 were transfused. Overall indices for the study population are CT ratio of 7.8:1, %T of 10.4% and TI of 0.15. Indices for surgical unit patients are CT ratio of 5:1, %T of 15.2% and TI of 0.29. By using the MSBOS total of 1403 cross matches could have been avoided. ConclusionsBy implementing the MSBOS 92% of cross matches for elective surgeries could have been avoided. The results are on par with the previous studies done at tertiary health care centres.

Efficiency of Blood Utilization in Elective Oncosurgeries in a Tertiary Care Cancer Centre: A Case for Data Disaggregation.

Oncosurgeries based on radical resection significantly increase the chances of intraoperative blood transfusion which leads to blood requisition based on subjective anticipation. Periodic audit and revisiting practice based on disaggregating data on the basis of surgical region could preserve blood, which is a scarce resource globally. This report proposes to use the results for reviewing the existing blood ordering schedule, in addition to proposing wider adoption in other cancer institutes using this report as a template. A retrospective analysis was performed for the entire patient cohort who underwent elective oncosurgeries between January 1, 2020, and January 31, 2021, and for whom blood reservation was done. Number of blood units cross matched and transfused for each patient for each surgery was noted. Efficiency of blood utilization was calculated using cross match transfusion ratio (CTR), transfusion probability (TP), and transfusion index (TI) indices and, finally, maximum surgical blood order schedule (MSBOS) was computed. Out of 718 elective oncosurgeries performed, blood requisition of 710 units was made for 345 procedures. Of the total units cross matched, only 76 units (10.70%) were transfused, leaving 89.29% units unutilized. Overall, CTR, TP, and TI were 9.34, 11.59%, and 0.22, respectively. Head and neck surgeries had the highest number of patients cross matched as well as units reserved, but not transfused. Conversely, abdominal surgeries had the highest transfusion probability. There is inefficient blood utilization in elective oncosurgeries and we recommend implementation of MSBOS based on anatomic region to improve efficiency of blood utilization.

Maximum Surgical Blood Order Schedule (MSBOS) for Cardio - Thoracic &amp; Vascular Interventions in an Apex Tertiary Care Hospital of India

Maximum Surgical Blood Order Schedule (MSBOS) for Cardio - Thoracic &amp; Vascular Interventions in an Apex Tertiary Care Hospital of India

Predictive modeling to create a proactive approach to patient blood management in the oncology population.

332 Background: Patient safety concerns that arose during COVID-19, related to blood shortages at a large oncological transfusion center, foregrounded the need for predictive modeling tools to optimize blood product inventory control. A maximum surgical blood ordering schedule (MSBOS), is a tool used to assist clinicians in predicting intraoperative blood usage based on retrospective historical data within an institution. Although MSBOS proves to be valuable, it is rudimentary in nature. Not only is data collection cumbersome but the data generated may not reflect current surgical practices and inter-patient variability may skew procedural averages. Predictive blood modeling is contingent generation of a digital health dashboard (DHB). DHB are electronically embedded in the electronic health record (EHR) to collect perioperative data. Coupling the generated informatics (patient demographics, diagnosis, laboratory results, procedural type, medications/supplements, surgeon) with machine learning allows for creation of patient-centered predictive blood modeling algorithms and better inventory control. Methods: To characterize blood use across various procedures at our institution, we engaged information technology specialists to create a Web Intelligence report by integrating data from both an EHR and a lab information system (LIS) into a single repository. Information obtained illuminated a master procedure list, blood product usage patterns, and characterized patient demographics during January - March, 2020. Data is continuously extracted to create a perpetually updated MSBOS while secondarily functioning to cultivate data for future predictive machine learning algorithms. Results: Data analysis demonstrated 5598 procedures were performed during the first quarter of 2020. Procedures not transfused with packed red blood cells (pRBCs) totaled to 4,156 and 1,442 had a greater than or equal to 10% probability of requiring pRBCs. Our current practices reflected our overall crossmatch to transfusion ratio ( C:T) was 5.4 to 1. Concerted collaboration, resulting in preparation of pre-surgical blood product orders according laboratory generated MSBOS schedule could decrease the C:T to 1.7 to 1. Additionally, high intraprocedural pRBCs variability was identified in current procedural subtypes. Conclusions: Traditionally generated MSBOS are functionally limited and may not be reflective of current surgical practices. Additionally, inter-patient variability may distort some procedural type guidance. Creating an integrated data report, eliminates some of the inherent limitations of traditional MSBOS. Moving forward, the cultivated data if coupled with machine learning has the potential to create transferable proprietary algorithms that proactively predict individual patient transfusion needs.

Audit of Blood Utilization in a Tertiary Care Hospital

Context: Blood transfusion plays a vital role in saving lives. However, owing to its many side effects, it should be used judiciously. Aim: The aims of this study were: audit of blood utilization in our tertiary care set up, formulation of a maximum surgical blood ordering schedule (MSBOS) for procedures where a complete cross-match appears mandatory, and improvement in the efficiency of blood utilization in trauma care. Methods: All patients admitted to Lokmanya Tilak Municipal Medical College and General Hospital during the study period for whom cross-match requests were sent to blood bank were included in this study. They were divided into groups according to the departments under which they were admitted. Data were analyzed and cross-match to transfusion ratio (C/T ratio), transfusion index, and transfusion probability (%T) were calculated. C/T ratio was used as an index of the efficacy of blood ordering practice, and a ratio of &gt;2.5 was considered an indication of the excess cross match. Results: The maximum C/T ratio of 34.11 was noted in the Department of Cardiology. Only three departments (Artificial Kidney Dialysis, Pediatrics, and Medical Intensive Care Unit) showed effective utilization of blood. Minimum C/T ratio of 1.34 observed in the Department of Artificial Kidney Dialysis. Conclusion: We found gross over-ordering of blood by different departments. Hence we propose the formulation of a blood ordering schedule. We drafted a MSBOS which provides guidelines for frequently performed elective surgical procedures by recommending the maximum number of units of blood to be cross-matched preoperatively, implementation of which will result in more efficient use of blood.

Blood Transfusion Practice in Operating Rooms in Nemazee Hospital in Southern Iran.

The requests for blood products in elective surgeries exceed actual use, leading to financial wastage and loss of shelf-life. In this study, we assessed the blood transfusion indices in elective surgeries performed in the operating rooms. In this cross-sectional study, from January to June 2017, a total of 970 adult patients who underwent elective surgeries in the operating rooms of Nemazee hospital, a general referral hospital in southern Iran, were investigated. Demographic, clinical, and laboratory data, such as hemoglobin (Hb), hematocrit (Hct), platelets, prothrombin time (PT), and partial thromboplastin time (PTT) were gathered from medical records. Blood utilization was evaluated using the following indices: cross-match to transfusion ratio (C/T ratio), transfusion probability (T%), transfusion index (TI), and Maximum Surgical Blood Order Schedule (MSBOS). The overall C/T, T%, and TI ratios were 2.49, 46.6%, and 0.83 for all procedures, and the highest and lowest ratios pertained to the thoracic and cardiac surgeries, respectively. The C/T ratio was ≥2.5 for all surgical procedures except for cardiac surgeries. T% was <30 for thoracic and orthopedics surgeries and ≥30 for other surgical procedures. In all surgical procedures, TI was less than 0.5, except for cardiac surgeries. Also, the MSBOS was about 3 units for cardiac surgeries and ranged from 0.5 to 1 units in other surgeries. The results of this study showed a high quality blood transfusion practice in cardiac surgeries, possibly due to more focus on this critical ward. Assessing difficulties in the process of reservation, utilization, and preparation of standard protocols and policies are required to improve the blood utilization practice in operating rooms.