With blood supplies at low levels, and replacement and utilization becoming important issues throughout the nation, the Oregon Medical Professional Review Organization (OMPRO) looked at the blood replacement process in Oregon. The study addressed the utilization of type-and-screening and cross-matching in the acute care hospital setting-comparing the more common and expensive cross-match procedure to the less expensive and less utilized type-and-screen. The methodology involved two phases: (a) data collection, evaluation, and feedback to the hospitals and (b) post-monitoring. Although the study did not control for all possible variables, the post-monitoring results demonstrated an increase in the ratio from 0.569 (1992 data) to 0.577. For 1994, the total statewide transfusion cost was estimated at $5,909,700 as compared to $6,423,900 (1992 data)--a savings of more than $500,000 per year. By implementing minimal changes in the way blood is ordered and tested, hospitals can improve quality by maintaining a readily available blood supply, eliminating waste and saving money.