TY - JOUR
T1 - Challenges in reliable preoperative blood ordering
T2 - A qualitative interview study
AU - Yang, Phillip
AU - Zijlstra, Emma P.
AU - Hall, Bruce L.
AU - Gregory, Stephen H.
AU - Jackups, Ronald
AU - Li, Jing
AU - Abraham, Joanna
AU - Lou, Sunny S.
N1 - Publisher Copyright:
© 2024 AABB.
PY - 2024/10
Y1 - 2024/10
N2 - Background: Presurgical blood orders are important for patient safety during surgery, but excess orders can be costly to patients and the healthcare system. We aimed to assess clinician perceptions on the presurgical blood ordering process and perceived barriers to reliable decision-making. Methods: This descriptive qualitative study was conducted at a single large academic medical center. Semi-structured interviews were conducted with surgeons, anesthesiologists, nurse anesthetists, nurse practitioners working in preoperative assessment clinics, and transfusion medicine physicians to assess perceptions of current blood ordering processes. Interview responses were analyzed using an inductive open coding approach followed by thematic analysis. Results: Twenty-three clinicians were interviewed. Clinicians felt that the current blood ordering process was frequently inconsistent. One contributor was a lack of information on surgical transfusion risk, related to lack of experience in ordering clinicians, insufficient communication between stakeholders, high turnover in academic settings, and lack of awareness of the maximum surgical blood ordering schedule. Other contributors included differing opinions about the benefits and harms of over- and under-preparing blood products, leading to variation in transfusion risk thresholds between clinicians, and disagreement about the safety of emergency-release blood. Conclusion: Several barriers to reliable decision-making for presurgical blood orders exist. Future efforts to improve ordering consistency may benefit from improved information sharing between stakeholders and education on safe transfusion practices.
AB - Background: Presurgical blood orders are important for patient safety during surgery, but excess orders can be costly to patients and the healthcare system. We aimed to assess clinician perceptions on the presurgical blood ordering process and perceived barriers to reliable decision-making. Methods: This descriptive qualitative study was conducted at a single large academic medical center. Semi-structured interviews were conducted with surgeons, anesthesiologists, nurse anesthetists, nurse practitioners working in preoperative assessment clinics, and transfusion medicine physicians to assess perceptions of current blood ordering processes. Interview responses were analyzed using an inductive open coding approach followed by thematic analysis. Results: Twenty-three clinicians were interviewed. Clinicians felt that the current blood ordering process was frequently inconsistent. One contributor was a lack of information on surgical transfusion risk, related to lack of experience in ordering clinicians, insufficient communication between stakeholders, high turnover in academic settings, and lack of awareness of the maximum surgical blood ordering schedule. Other contributors included differing opinions about the benefits and harms of over- and under-preparing blood products, leading to variation in transfusion risk thresholds between clinicians, and disagreement about the safety of emergency-release blood. Conclusion: Several barriers to reliable decision-making for presurgical blood orders exist. Future efforts to improve ordering consistency may benefit from improved information sharing between stakeholders and education on safe transfusion practices.
KW - blood management
KW - clinician practice patterns
KW - perioperative medicine
KW - transfusion practices (adult)
UR - http://www.scopus.com/inward/record.url?scp=85204032146&partnerID=8YFLogxK
U2 - 10.1111/trf.18012
DO - 10.1111/trf.18012
M3 - Article
C2 - 39279676
AN - SCOPUS:85204032146
SN - 0041-1132
VL - 64
SP - 1889
EP - 1898
JO - Transfusion
JF - Transfusion
IS - 10
ER -