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TIMOTHY O. MORGAN is Executive Director, Pennsylvania Hospital, 800 Spruce Street, Philadelphia, PA 19107 (timorg{at}pahosp.com).

Purpose. Blood conservation programs have been successfully implemented in hospitals in which an overarching commitment to the reduction of the number of blood transfusions existed. This review will describe the rationale and some of the considerations involved in starting such a program. Summary. Management of a hospital’s blood supply is a high pressure area dominated by a resource shortage, increasing costs, a medical community that has been trained to use transfusion, public awareness and concern, and to a lesser extent an increasing body of evidence suggesting that transfusions are often deleterious. The implementation of new techniques and protocols to conserve blood during surgery can be facilitated if a physician champion addresses the medical staff and the hospital administrators clear political and budgetary issues. With a team approach and an understanding of the clinical and economic evidence supporting less blood use, many of the hurdles can be overcome. Conclusion. Blood conservation programs offer a solution to the multiple problems that surround blood use. When successfully implemented, such initiatives reduce safety concerns, hospital spending, and the dependency of hospitals on the national blood supply and improve clinical outcomes and patient satisfaction. Index terms: Blood; Control, quality; Coronary artery bypass; Costs; Economics; Hospitals; Protocols; Risk management; Team; Toxicity