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Moving from “Surgeries” to Patients: Progress and Pitfalls While Using Machine Learning to Personalize Transfusion Prediction. Anesthesiology 2022; 137:9-12. [DOI: 10.1097/aln.0000000000004250] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Garvanovic SH, Gatling JW, Wang AT, Wong CM, Stevens WT, Lauer RE, Ramsingh D. Using Lean Six Sigma to Decrease Delivery Time of Blood Products to the Operating Room. A A Pract 2021; 15:e01463. [PMID: 33973884 DOI: 10.1213/xaa.0000000000001463] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Lean Six Sigma (LSS) is a process improvement strategy used in many industries. Its goal is to improve performance and quality by eliminating waste, optimizing flow, and reducing variability. This article describes LSS methods and their application in health care. We detail a successful quality improvement (QI) initiative in which we tested LSS tools to evaluate and enhance our institution's blood product delivery to the operating room (OR). Incorporating LSS-driven changes resulted in a revised workflow, which decreased personnel workload and significantly reduced delivery time. We hope this article will encourage other health care institutions to integrate LSS strategies into their workflows.
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Affiliation(s)
- Samantha H Garvanovic
- From the Department of Anesthesiology, Loma Linda University Medical Center, Loma Linda, California
| | - Jason W Gatling
- From the Department of Anesthesiology, Loma Linda University Medical Center, Loma Linda, California
| | - Annie T Wang
- From the Department of Anesthesiology, Loma Linda University Medical Center, Loma Linda, California
| | - Christine M Wong
- Department of Anesthesiology, Children's Hospital of Los Angeles, Los Angeles, California
| | - Wesley T Stevens
- Department of Pathology, Loma Linda University Medical Center, Loma Linda, California
| | - Ryan E Lauer
- From the Department of Anesthesiology, Loma Linda University Medical Center, Loma Linda, California
| | - Davinder Ramsingh
- From the Department of Anesthesiology, Loma Linda University Medical Center, Loma Linda, California
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McGovern PE, Wu L, Rao S, Ahumada L, Friedman DF, Nance ML, Gálvez JA. Audit of blood product utilization in the care of injured children. Paediatr Anaesth 2021; 31:186-196. [PMID: 33190350 DOI: 10.1111/pan.14077] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Revised: 11/05/2020] [Accepted: 11/08/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND Blood product utilization in injured children is poorly characterized; the decision to prepare products or transfuse patients can be difficult due to a lack of reliable evidence of transfusion needs across pediatric age-groups and injury types. We conducted an audit of transfusion practices in pediatric trauma based on age, injuries, and mechanism of injury. METHODS We reviewed and cross-referenced blood product transfusion practice data from the trauma registry and the anesthesia transfusion record database at a level 1 pediatric trauma center over a 10-year period. Demographic data, injury severity scores, and survival statistics were obtained from the trauma registry. Transfusion rates are reported separately for hospital admission and for intraoperative transfusions for procedures performed during the first two hospital days. Descriptive statistical analysis was used to compare specific groups based on age, injury type, and mechanism of injury. RESULTS We report 14 569 trauma admissions of 14 606 patients. The transfusion rate during the admission was 1.56% (227/14 569). 4591 (30.9%) admissions had surgical interventions in first two days of hospitalization with an intraoperative transfusion rate of 2.98%. Patients younger than one year had the highest transfusion rate during admission (2.8%), and the highest transfusion rate during surgical procedures performed in the first two days of the admission (18.87%). Admissions due to vascular injuries had the highest transfusion rates in infancy followed by hollow visceral injuries in adolescents (71.4% and 25%, respectively). Vascular injuries in most age-groups also had high transfusion rates ranging from 11% in 5- to 9-year age-group to 71% in infants. Mechanisms with the highest transfusion rates were firearm wounds in patients older than one year and vehicular accidents for patients younger than one year. CONCLUSIONS The overall blood product needs in the pediatric trauma population are low (1.56%). Selected populations requiring higher rates of need include infants younger than one year, and children with thoracic and vascular injuries. Understanding transfusion patterns is important to optimize resource allocation.
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Affiliation(s)
- Patrick E McGovern
- Division of Pediatric General, Thoracic and Fetal Surgery, The Children's Hospital of Philadelphia, Philadelphia, PA, USA.,Department of Surgery, Temple University Hospital, Philadelphia, PA, USA
| | - Lezhou Wu
- Department of Biomedical & Health Informatics, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Sieta Rao
- Division of Pediatric General, Thoracic and Fetal Surgery, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Luis Ahumada
- Predictive Analytics, Johns Hopkins All Children's Hospital, St. Petersburg, FL, USA
| | - David F Friedman
- Blood Bank and Transfusion Medicine Division, The Children's Hospital of Philadelphia, Philadelphia, PA, USA.,Department of Pediatrics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Michael L Nance
- Division of Pediatric General, Thoracic and Fetal Surgery, The Children's Hospital of Philadelphia, Philadelphia, PA, USA.,Department of Surgery, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Jorge A Gálvez
- Department of Biomedical & Health Informatics, The Children's Hospital of Philadelphia, Philadelphia, PA, USA.,Department of Anesthesiology & Critical Care Medicine, The Children's Hospital of Philadelphia, Philadelphia, PA, USA.,Department of Anesthesiology & Critical Care, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
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Al Khan S, Rosinski K, Petraszko T, Dawe P, Hwang BW, Sham L, Hudoba M, Roland K, Shih AW. Reducing AB plasma utilisation through the AB plasma appropriateness index. Transfus Med 2019; 29:381-388. [PMID: 31576629 DOI: 10.1111/tme.12632] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2019] [Revised: 08/17/2019] [Accepted: 08/19/2019] [Indexed: 11/30/2022]
Abstract
OBJECTIVES We hypothesised that there was inappropriate group AB plasma used in our hospital, identifiable by a novel key quality indicator (KQI) and mitigable through massive transfusion protocol (MTP) modification. BACKGROUND Group AB plasma is a scarce resource strained by increasing usage worldwide when used as universal donor plasma in non-group AB patients. To reduce inappropriate use and to promote benchmarking to the best practice, we developed the AB plasma appropriateness index (ABAI). ABAI is the ratio of AB plasma transfused to group AB or unknown blood group patients to all AB plasma utilised, where values closer to 1 are better. METHODS Data collected included AB plasma disposition by blood group, indications for transfusion, total blood utilisation, patient clinical characteristics and outcomes. ABAI during a 12-month period was retrospectively assessed, which led to implementation of pre-thawed group A plasma instead of group AB plasma for trauma patients starting in July 2017. RESULTS The ABAI retrospectively showed inappropriate use in non-group AB patients in our hospital, the majority used to avoid expiry after thaw. When comparing 1-year pre- and post-implementation periods, ABAI improved from 0·464 to 0·900 (P < 0·0001). After exclusion of therapeutic plasma exchange, ABAI still improved (0·486-0·720, P < 0·0001). No differences in the length of stay or mortality associated in 32 patients receiving group A plasma for emergency release were observed. CONCLUSION The ABAI is a novel KQI to indicate inappropriate AB plasma usage for quality improvement. This led to thawed A plasma use for MTPs, reducing inappropriate AB plasma usage.
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Affiliation(s)
- S Al Khan
- Blood Bank Services, Directorate General of Specialized Medical Care, Ministry of Health, Muscat, Oman
| | - K Rosinski
- Vancouver Coastal Health Authority, Vancouver, British Columbia, Canada
| | - T Petraszko
- Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada.,Canadian Blood Services, Vancouver, British Columbia, Canada
| | - P Dawe
- Vancouver Coastal Health Authority, Vancouver, British Columbia, Canada.,Department of Surgery, University of British Columbia, Vancouver, British Columbia, Canada
| | - B W Hwang
- Vancouver Coastal Health Authority, Vancouver, British Columbia, Canada
| | - L Sham
- Vancouver Coastal Health Authority, Vancouver, British Columbia, Canada
| | - M Hudoba
- Vancouver Coastal Health Authority, Vancouver, British Columbia, Canada.,Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - K Roland
- Vancouver Coastal Health Authority, Vancouver, British Columbia, Canada.,Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - A W Shih
- Vancouver Coastal Health Authority, Vancouver, British Columbia, Canada.,Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, British Columbia, Canada
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Kinnear SB, Kinnear N, Bolt J. Intraoperative Cell Salvage During Transurethral Resection of Prostate: A Case Report. A A Pract 2019; 12:238-240. [PMID: 30277899 DOI: 10.1213/xaa.0000000000000895] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Intraoperative cell salvage (ICS) became commercially available in 1968 and has enjoyed wide uptake. However, its use in transurethral resection of prostate (TURP) remains rare. We describe a 71-year-old man who underwent TURP with incomplete blood cross-matching. He suffered significant hemorrhage requiring return to theater. There was great delay in obtaining appropriately cross-matched blood, due to previous alloimmunization. ICS was used to retrieve blood present in bladder irrigation. This is the first Australian report of ICS use during TURP. This case led to a change in our practice and serves to demonstrate the potential of this technology during emergencies.
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Affiliation(s)
- Stephen B Kinnear
- From St Andrew's Hospital, Adelaide, South Australia, Australia.,Department of Anaesthesia, Flinders Medical Centre, Bedford Park, South Australia, Australia
| | - Ned Kinnear
- Department of Urology, Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - John Bolt
- From St Andrew's Hospital, Adelaide, South Australia, Australia.,Department of Urology, Royal Adelaide Hospital, Adelaide, South Australia, Australia
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Patel SY, Edwards DA, Boulware DC, Serdiuk A, Cook SJ, Benson K, Rice MJ. A novel approach to improving efficiency and cost saving in preoperative blood preparation. Transfusion 2017; 57:3035-3039. [PMID: 28940392 DOI: 10.1111/trf.14331] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2017] [Revised: 07/31/2017] [Accepted: 07/31/2017] [Indexed: 12/28/2022]
Abstract
BACKGROUND Preoperative ordering of blood products has been an area of optimization due to considerable variability among physicians; overpreparation can lead to extra costs and underpreparation of blood can potentially compromise patient safety. STUDY DESIGN AND METHODS We examined the potential cost savings of extending the storage interval of a presurgical type-and-screen sample from 7 to 14 days, thereby reducing the need for a new specimen on the day of surgery. RESULTS Sensitivity analysis showed annual cost savings for our institution to be an estimated $38,770 ($22,420-$73,120). CONCLUSION These results are even more robust when incorporating the additional potential savings from improved operating room efficiency.
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Affiliation(s)
- Sephalie Y Patel
- Department of Anesthesiology, H. Lee Moffitt Cancer Center, Tampa, Florida
| | - David A Edwards
- Department of Anesthesiology, Vanderbilt University School of Medicine, Nashville, Tennessee
| | - David C Boulware
- Department of Biostatistics, H. Lee Moffitt Cancer Center, Tampa, Florida
| | - Andrew Serdiuk
- Department of Anesthesiology, H. Lee Moffitt Cancer Center, Tampa, Florida
| | - Susan J Cook
- Blood Bank, H. Lee Moffitt Cancer Center, Tampa, Florida
| | - Kaaron Benson
- Department of Hematopathology and Laboratory Medicine, H. Lee Moffitt Cancer Center, Tampa, Florida
| | - Mark J Rice
- Department of Anesthesiology, Vanderbilt University School of Medicine, Nashville, Tennessee
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Thompson RM, Thurm CW, Rothstein DH. Interhospital Variability in Perioperative Red Blood Cell Ordering Patterns in United States Pediatric Surgical Patients. J Pediatr 2016; 177:244-249.e5. [PMID: 27453372 DOI: 10.1016/j.jpeds.2016.06.080] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2016] [Revised: 05/16/2016] [Accepted: 06/27/2016] [Indexed: 10/21/2022]
Abstract
OBJECTIVE To evaluate perioperative red blood cell (RBC) ordering and interhospital variability patterns in pediatric patients undergoing surgical interventions at US children's hospitals. STUDY DESIGN This is a multicenter cross-sectional study of children aged <19 years admitted to 38 pediatric tertiary care hospitals participating in the Pediatric Health Information System in 2009-2014. Only cases performed at all represented hospitals were included in the study, to limit case mix variability. Orders for blood type and crossmatch were included when done on the day before or the day of the surgical procedure. The RBC transfusions included were those given on the day of or the day after surgery. The type and crossmatch-to-transfusion ratio (TCTR) was calculated for each surgical procedure. An adjusted model for interhospital variability was created to account for variation in patient population by age, sex, race/ethnicity, payer type, and presence/number of complex chronic conditions (CCCs) per patient. RESULTS A total of 357 007 surgical interventions were identified across all participating hospitals. Blood type and crossmatch was performed 55 632 times, and 13 736 transfusions were provided, for a TCTR of 4:1. There was an association between increasing age and TCTR (R(2) = 0.43). Patients with multiple CCCs had lower TCTRs, with a stronger relationship (R(2) = 0.77). There was broad variability in adjusted TCTRs among hospitals (range, 2.5-25). CONCLUSIONS The average TCTR in US children's hospitals was double that of adult surgical data, and was associated with wide interhospital variability. Age and the presence of CCCs markedly influenced this ratio. Studies to evaluate optimal preoperative RBC ordering and standardization of practices could potentially decrease unnecessary costs and wasted blood.
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Affiliation(s)
- Rachel M Thompson
- Department of Orthopedic Surgery, Texas Scottish Rite Hospital for Children, Dallas, TX
| | - Cary W Thurm
- Children's Hospital Association, Overland Park, KS
| | - David H Rothstein
- Department of Pediatric Surgery, Women and Children's Hospital of Buffalo and University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, NY.
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Ejaz A, Frank SM, Spolverato G, Mavros M, Kim Y, Pawlik TM. Variation in the use of type and crossmatch blood ordering among patients undergoing hepatic and pancreatic resections. Surgery 2015; 159:908-18. [PMID: 26384235 DOI: 10.1016/j.surg.2015.07.029] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2015] [Revised: 06/25/2015] [Accepted: 07/15/2015] [Indexed: 10/23/2022]
Abstract
BACKGROUND The use of preoperative blood orders involved in major gastrointestinal surgery has been poorly studied. The objective of the current study was to analyze compliance with guidelines and factors associated with crossmatch and blood ordering among patients who underwent a hepatic or pancreatic resection. METHODS All patients who underwent a hepatic or pancreatic resection between 2010 and 2013 at Johns Hopkins Hospital were identified. Crossmatch to transfusion (C/T) ratios were calculated based on transfusion rates and total units used. A C/T ratio of >2.0 was considered excessive. RESULTS Among the 2,629 patients, 11,574 units of packed red blood cells (PRBCs) were crossmatched (mean number of PRBC units crossmatched: 5.9 ± 7.3). Of the 2,629 patients, 34.1% of patients received ≥ 1 PRBCs and 3,611 total units of PRBC were transfused, resulting in an institutional C/T ratio of 2.17 based on the proportion of patients transfused and 3.21 based on the overall number of PRBC units transfused. Using our criterion of excessive C/T ratio of >2.0, we found that 411 patients (45.9%) were "excessively" crossmatched among transfused patients. Among nontransfused patients, 41.0% (n = 711) of patients were crossmatched for >2 units PRBC. Factors associated with receipt of "excess" crossmatch included the presence of multiple comorbidities and an estimated blood loss >450 mL (both P < .05). Provider-level variation among surgeons (C/T ratio range 1.22-3.81) also was associated strongly with "excess" crossmatching ratios (odds ratio 2.56, 95% confidence interval 2.09-3.13; P < .001). CONCLUSION More than 1 in 4 patients received crossmatch orders that exceeded institutional and national guidelines. Provider variation both among surgeons and anesthesiologists was an important factor associated with crossmatch variation and excessive ordering of blood for crossmatch in patients undergoing pancreatic and hepatic surgery.
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Affiliation(s)
- Aslam Ejaz
- Department of Surgery, University of Illinois Hospital and Health Sciences System, Chicago, IL
| | - Steven M Frank
- Department of Anesthesiology/Critical Care Medicine, Interdisciplinary Blood Management Program, The Johns Hopkins Hospital, Baltimore, MD
| | - Gaya Spolverato
- Department of Surgery, The Johns Hopkins Hospital, Baltimore, MD
| | - Michael Mavros
- Department of Surgery, The Johns Hopkins Hospital, Baltimore, MD
| | - Yuhree Kim
- Department of Surgery, The Johns Hopkins Hospital, Baltimore, MD
| | - Timothy M Pawlik
- Department of Surgery, The Johns Hopkins Hospital, Baltimore, MD.
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9
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White MJ, Hazard SW, Frank SM, Boyd JS, Wick EC, Ness PM, Tobian AAR. The evolution of perioperative transfusion testing and blood ordering. Anesth Analg 2015; 120:1196-203. [PMID: 25988630 DOI: 10.1213/ane.0000000000000619] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
The evolution of modern anesthesia and surgical practices has been accompanied by enhanced supportive procedures in blood banking and transfusion medicine. There is increased focus on the preparation and the use of blood components including, but not limited to, preventing unnecessary type and screen/crossmatch orders, decreasing the time required to provide compatible red blood cells (RBCs), and reducing the waste of limited blood and personnel resources. The aim of this review is to help the anesthesiologist and surgical staff identify patients at highest risk for surgical bleeding. In addition, this review examines how anesthesia and transfusion medicine can efficiently and safely allocate blood components for surgical patients who require transfusions. The following databases were searched: PubMed, EMBASE, Google Scholar, and the Cochrane Library from January 1970 through March 2014. Subsequent reference searches of retrieved articles were also assessed. Several innovations have drastically changed the procedures by which blood is ordered, inventoried, and the speed in which blood is delivered for patient care. Before entering an operating room, patient blood management provides guidance to clinicians about when and how to treat preoperative anemia and intra- and postoperative strategies to limit the patient's exposure to blood components. Timely updates of the recommendations for blood orders (maximum surgical blood ordering schedule) have enhanced preoperative decision making regarding the appropriateness of the type and screen versus the type and crossmatch order. The updated maximum surgical blood ordering schedule reflects modern practices, such as laparoscopy, improved surgical techniques, and use of hemostatic agents resulting in a more streamlined process for ordering and obtaining RBCs. The electronic (computer) crossmatch and electronic remote blood issue have also dramatically reduced the amount of time required to obtain crossmatch-compatible RBCs when compared with the more traditional serologic crossmatch methods. These changes in blood banking methods have resulted in more efficient delivery of blood to surgical patients.
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Affiliation(s)
- Marissa J White
- From the *Department of Pathology, Division of Transfusion Medicine, The Johns Hopkins University School of Medicine, Baltimore, Maryland; †Department of Anesthesiology and Critical Care Medicine, The Johns Hopkins University School of Medicine, Baltimore, Maryland; ‡Department of Anesthesiology, Penn State College of Medicine, Hershey, Pennsylvania; and §Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland
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Tayara BK, Al-Faraidy MH, Al-Sayel FA, Al-Omran AS, Sadat-Ali M. Blood utilization in orthopedic and trauma practice. Int J Appl Basic Med Res 2015; 5:111-3. [PMID: 26097818 PMCID: PMC4456884 DOI: 10.4103/2229-516x.157156] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2014] [Accepted: 02/22/2015] [Indexed: 11/24/2022] Open
Abstract
Objectives: Very little is known about blood utilization in orthopedic and trauma surgery and there is no definite policy in this regard. Our objective is to perform an audit on our practice of blood utilization in the orthopedic department. Methods: We have retrospectively analyzed the data of patients who were admitted between January 2011 and December 2012 to the orthopedic male, female and pediatric wards for which blood products were requested. Results: Three hundred and eight patients were admitted for surgery during the study period. The average age was 35.12 ± 20.4 years and postsurgery they stayed in the hospital for 25.60 ± 10.5 days. Blood products were requested for 223 trauma surgeries. In elective orthopedic procedures, only 42.78% of the blood requested was utilized while in trauma patients it was 55.25%. Conclusions: A substantial amount of blood and its product was used in trauma and elective orthopedic surgeries. There was a major discrepancy between the blood requested and utilized and secondly in the majority single unit transfusion was utilized, which is not within the fundamentals of blood transfusion.
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Affiliation(s)
- Bader Kamal Tayara
- Department of Orthopaedic Surgery, College of Medicine, King Fahd Hospital of the University, Al Khobar, Saudi Arabia
| | - Moaad Hatim Al-Faraidy
- Department of Orthopaedic Surgery, College of Medicine, King Fahd Hospital of the University, Al Khobar, Saudi Arabia
| | - Faisal Abdullah Al-Sayel
- Department of Orthopaedic Surgery, College of Medicine, King Fahd Hospital of the University, Al Khobar, Saudi Arabia
| | - Abdallah S Al-Omran
- Department of Orthopaedic Surgery, College of Medicine, King Fahd Hospital of the University, Al Khobar, Saudi Arabia
| | - Mir Sadat-Ali
- Department of Orthopaedic Surgery, College of Medicine, King Fahd Hospital of the University, Al Khobar, Saudi Arabia
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Abstract
Pretransfusion testing is reviewed for the anesthesiologist, with an emphasis on the electronic crossmatch and transfusion of uncrossmatched erythrocytes when testing is incomplete.
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Reducing unnecessary preoperative blood orders and costs by implementing an updated institution-specific maximum surgical blood order schedule and a remote electronic blood release system. Anesthesiology 2014; 121:501-9. [PMID: 24932853 DOI: 10.1097/aln.0000000000000338] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND Using blood utilization data acquired from the anesthesia information management system, an updated institution-specific maximum surgical blood order schedule was introduced. The authors evaluated whether the maximum surgical blood order schedule, along with a remote electronic blood release system, reduced unnecessary preoperative blood orders and costs. METHODS At a large academic medical center, data for preoperative blood orders were analyzed for 63,916 surgical patients over a 34-month period. The new maximum surgical blood order schedule and the electronic blood release system (Hemosafe; Haemonetics Corp., Braintree, MA) were introduced mid-way through this time period. The authors assessed whether these interventions led to reductions in unnecessary preoperative orders and associated costs. RESULTS Among patients having surgical procedures deemed not to require a type and screen or crossmatch (n = 33,216), the percent of procedures with preoperative blood orders decreased by 38% (from 40.4% [7,167 of 17,740 patients] to 25.0% [3,869 of 15,476 patients], P < 0.001). Among all hospitalized inpatients, the crossmatch-to-transfusion ratio decreased by 27% (from 2.11 to 1.54; P < 0.001) over the same time period. The proportion of patients who required emergency release uncrossmatched blood increased from 2.2 to 3.1 per 1,000 patients (P = 0.03); however, most of these patients were having emergency surgery. Based on the realized reductions in blood orders, annual costs were reduced by $137,223 ($6.08 per patient) for surgical patients, and by $298,966 ($6.20/patient) for all hospitalized patients. CONCLUSION Implementing institution-specific, updated maximum surgical blood order schedule-directed preoperative blood ordering guidelines along with an electronic blood release system results in a substantial reduction in unnecessary orders and costs, with a clinically insignificant increase in requirement for emergency release blood transfusions.
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Prevention of surgical delays by pre-admission type and screen in patients with scheduled surgical procedures: improved efficiency. BLOOD TRANSFUSION = TRASFUSIONE DEL SANGUE 2014; 13:310-2. [PMID: 25369595 DOI: 10.2450/2014.0172-14] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Subscribe] [Scholar Register] [Received: 07/08/2014] [Accepted: 09/10/2014] [Indexed: 11/21/2022]
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Optimizing Preoperative Blood Ordering with Data Acquired from an Anesthesia Information Management System. Anesthesiology 2013; 118:1286-97. [DOI: 10.1097/aln.0b013e3182923da0] [Citation(s) in RCA: 85] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Abstract
Background:
The maximum surgical blood order schedule (MSBOS) is used to determine preoperative blood orders for specific surgical procedures. Because the list was developed in the late 1970s, many new surgical procedures have been introduced and others improved upon, making the original MSBOS obsolete. The authors describe methods to create an updated, institution-specific MSBOS to guide preoperative blood ordering.
Methods:
Blood utilization data for 53,526 patients undergoing 1,632 different surgical procedures were gathered from an anesthesia information management system. A novel algorithm based on previously defined criteria was used to create an MSBOS for each surgical specialty. The economic implications were calculated based on the number of blood orders placed, but not indicated, according to the MSBOS.
Results:
Among 27,825 surgical cases that did not require preoperative blood orders as determined by the MSBOS, 9,099 (32.7%) had a type and screen, and 2,643 (9.5%) had a crossmatch ordered. Of 4,644 cases determined to require only a type and screen, 1,509 (32.5%) had a type and crossmatch ordered. By using the MSBOS to eliminate unnecessary blood orders, the authors calculated a potential reduction in hospital charges and actual costs of $211,448 and $43,135 per year, respectively, or $8.89 and $1.81 per surgical patient, respectively.
Conclusions:
An institution-specific MSBOS can be created, using blood utilization data extracted from an anesthesia information management system along with our proposed algorithm. Using these methods to optimize the process of preoperative blood ordering can potentially improve operating room efficiency, increase patient safety, and decrease costs.
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Yazer M, Eder AF, Land KJ. How we manage AB plasma inventory in the blood center and transfusion service. Transfusion 2013; 53:1627-33. [PMID: 23614505 DOI: 10.1111/trf.12223] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2013] [Revised: 03/12/2013] [Accepted: 03/20/2013] [Indexed: 11/28/2022]
Abstract
The growing use of group AB plasma in the United States in recent years poses unique challenges to blood centers and transfusion services. Blood centers must collect sufficient plasma components from a limited pool of group AB donors while taking steps to improve transfusion safety that further restricts the available supply. Transfusion services, on the other hand, must use the finite resource in the most conscientious and medically appropriate manner. Recently, many investigations have challenged long-held beliefs about transfusion practice and appropriate indications for blood components across a variety of specialties. Balancing supply and demand of group AB plasma requires collaboration between blood suppliers and transfusion services, and opportunities for improvement exist on both sides of the equation.
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Affiliation(s)
- Mark Yazer
- Department of Pathology, University of Pittsburgh and The Institute for Transfusion Medicine, Pittsburgh, Pennsylvania, USA
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