Preoperative cross match guidelines were developed from a review of elective surgical hemotherapy. Six elective surgical procedures were studied prospectively to determine the effectiveness of the recommendations. All six procedures demonstrated a substantial reduction in preoperative cross match ordering during the study period, although for only one procedure was the guidelines' recommendation followed strictly. For those procedures that rarely required hemotherapy, an ABO-Rh typing and an antibody detection test were recommended as a preoperative study without a cross match. Through education of the clinical staff, successful establishment of these guidelines can lead to substantial monetary savings, reduced blood outdating, and a decreased blood bank workload with a more appropriate allocation of the technologists' time and effort.