The latest guidance in GIRFT’s series of preoperative assessment (POA) resources outlines how trusts can reduce preoperative Group and Save blood type testing for patients having knee and hip replacement surgery, helping to prevent unnecessary postponements and avoidable on-the-day cancellations.
The Group and Save (G&S) test is carried out to identify a patient’s blood type ahead of procedures where the chance of the patient needing a blood transfusion is unlikely but still conceivable. It is common practice in England for two blood tests to be taken for blood group validation, with the second test required to confirm the first result.
However, as blood test samples need to be current, can only be stored for a short period of time and results are generally not interoperable between provider sites, delivering G&S tests to the required national standard can be a logistical challenge, leading to repeated visits for patients.
GIRFT observed the work of the team at the Oxford Nuffield Orthopaedic Centre, where the use G&S has been eliminated in the period before patients have their elective hip and knee surgery, in accordance with strict criteria. This has resulted in improved efficiency, a reduction in cancellations and a reduced carbon footprint.
The new GIRFT guidance advocates that – subject to inclusions, exclusions and safety requirements, which are outlined in the document – trusts should stop routinely performing preoperative G&S testing for patients undergoing elective primary knee and hip replacement.
The aim is that teams who are involved in the POA and treatment of patients undergoing primary hip and knee replacement will use the guide to identify suitable patients for whom preoperative G&S testing can be eliminated, in turn:
- Reducing unnecessary sampling;
- Reducing costs;
- Enabling trusts to deliver more high volume low complexity (HVLC) lists;
- Eliminating on-the-day changes due to delays in receiving test results;
- Reducing cancellations on the day;
- Reducing hospital visits for unnecessary testing, which is better for the patient and will reduce carbon footprint.
This guidance is co-badged by the National Transfusion Practitioner Network, National Blood Transfusion Committee and British Orthopaedic Association.
It is part of a wider GIRFT series designed to support providers to streamline their preoperative screening and diagnostic pathways and ensure testing is appropriately targeted, in accordance with current guidance and evidence. Other guides in the series can be found on the GIRFT Theatre Productivity page under ‘Guidance’.
