A 6-month prospective audit was carried out in three surgical departments of a district general hospital. Over that period, 2720 units of red cells were electively cross-matched, 957 being transfused. The overall cross-match-to-transfusion ratio (CTR) was 2.8, but this varied from over 40 for some gynaecological procedures to 1.5 for major surgical procedures. The average CTR for general surgery was 2.2, orthopaedics 2.3, and obstetrics and gynaecology 5.7. A maximum surgical blood ordering system (MSBOS) was introduced and a second 6-month audit carried out. The number of units cross-matched had fallen by 36% to 1746, with a CTR of 1.8. The change in activity had led to a saving conservatively estimated at 11,616.00 Pounds per annum. Local audit and the introduction of a MSBOS in a district general hospital is an exercise which can demonstrate inefficiencies in blood ordering practices and can lead to large financial savings without detracting from standards of patient care.