BACKGROUND: The maximum surgical blood order schedule (MSBOS) is a viable option for reducing unnecessary crossmatching and achieving significant cost savings in the blood bank. In this study, we showed the process establishing MSBOS and through a prospective study, we evaluated the efficacy of MSBOS. METHODS: We organized task force team for transfusion management improvement composed of a director of the blood bank, surgeons and anesthesiologists in the Committee for Quality Improvement (CQI) of Asan Medical Center. In this team, we established MSBOS for most elective surgeries through the review of the previous transfusion and crossmatching data. We introduced MSBOS in April 1998 and prospectively analyzed surgeon's acceptance rate of MSBOS, crossmatch-to-transfusion ratio (C/T ratio), blood wastage rate, and cost savings. RESULTS: During the first 19 months after introducing MSBOS at our hospital, there was gradual increase in the surgeon's compliance rate of MSBOS from 30% to 94.0% through continuous education. The C/T ratio was changed from 3.5 to 1.6 and blood wastage rate was decreased from 4.0% to 1.9%. And also we could save more than 38,400,000 won through not performing the unnecessary crossmatches of 7,680 cases per year. CONCLUSION: Introduction of MSBOS can have a significant impact in reducing C/T ratio, blood wastage rate, and unnecessary crossmatches for the unused blood units. For successful application of MSBOS, cooperation with surgeons and anesthesiologists and continuous education is essential.