TY - JOUR
T1 - Reducing perioperative red blood cell unit issue orders, returns, and waste using failure modes and effects analysis
AU - Lou, Sunny S.
AU - Dewey, Megan M.
AU - Bollini, Mara L.
AU - Harford, Derek R.
AU - Ingold, Cindy
AU - Wildes, Troy S.
AU - Stevens, Tracey W.
AU - Martin, Jackie L.
AU - Grossman, Brenda J.
AU - Kangrga, Ivan
N1 - Funding Information:
This work was funded by Barnes‐Jewish Hospital Perioperative Services. Sunny S. Lou was supported by NIH 5T32GM108539‐07.
Funding Information:
This work was funded by Barnes-Jewish Hospital Perioperative Services. Sunny S. Lou was supported by NIH 5T32GM108539-07.
Publisher Copyright:
© 2023 AABB.
PY - 2023/4
Y1 - 2023/4
N2 - Background: Surgical transfusion has an outsized impact on hospital-based transfusion services, leading to blood product waste and unnecessary costs. The objective of this study was to design and implement a streamlined, reliable process for perioperative blood issue ordering and delivery to reduce waste. Study Design and Methods: To address the high rates of surgical blood issue requests and red blood cell (RBC) unit waste at a large academic medical center, a failure modes and effects analysis was used to systematically examine perioperative blood management practices. Based on identified failure modes (e.g., miscommunication, knowledge gaps), a multi-component action plan was devised involving process changes, education, electronic clinical decision support, audit, and feedback. Changes in RBC unit issue requests, returns, waste, labor, and cost were measured pre- and post-intervention. Results: The number of perioperative RBC unit issue requests decreased from 358 per month (SD 24) pre-intervention to 282 per month (SD 16) post-intervention (p <.001), resulting in an estimated savings of 8.9 h per month in blood bank staff labor. The issue-to-transfusion ratio decreased from 2.7 to 2.1 (p <.001). Perioperative RBC unit waste decreased from 4.5% of units issued pre-intervention to 0.8% of units issued post-intervention (p <.001), saving an estimated $148,543 in RBC unit acquisition costs and $546,093 in overhead costs per year. Discussion: Our intervention, designed based on a structured failure modes analysis, achieved sustained reductions in perioperative RBC unit issue orders, returns, and waste, with associated benefits for blood conservation and transfusion program costs.
AB - Background: Surgical transfusion has an outsized impact on hospital-based transfusion services, leading to blood product waste and unnecessary costs. The objective of this study was to design and implement a streamlined, reliable process for perioperative blood issue ordering and delivery to reduce waste. Study Design and Methods: To address the high rates of surgical blood issue requests and red blood cell (RBC) unit waste at a large academic medical center, a failure modes and effects analysis was used to systematically examine perioperative blood management practices. Based on identified failure modes (e.g., miscommunication, knowledge gaps), a multi-component action plan was devised involving process changes, education, electronic clinical decision support, audit, and feedback. Changes in RBC unit issue requests, returns, waste, labor, and cost were measured pre- and post-intervention. Results: The number of perioperative RBC unit issue requests decreased from 358 per month (SD 24) pre-intervention to 282 per month (SD 16) post-intervention (p <.001), resulting in an estimated savings of 8.9 h per month in blood bank staff labor. The issue-to-transfusion ratio decreased from 2.7 to 2.1 (p <.001). Perioperative RBC unit waste decreased from 4.5% of units issued pre-intervention to 0.8% of units issued post-intervention (p <.001), saving an estimated $148,543 in RBC unit acquisition costs and $546,093 in overhead costs per year. Discussion: Our intervention, designed based on a structured failure modes analysis, achieved sustained reductions in perioperative RBC unit issue orders, returns, and waste, with associated benefits for blood conservation and transfusion program costs.
KW - blood conservation
KW - perioperative blood management
KW - surgical transfusion practice
UR - http://www.scopus.com/inward/record.url?scp=85147519895&partnerID=8YFLogxK
U2 - 10.1111/trf.17275
DO - 10.1111/trf.17275
M3 - Article
C2 - 36752098
AN - SCOPUS:85147519895
SN - 0041-1132
VL - 63
SP - 755
EP - 762
JO - Transfusion
JF - Transfusion
IS - 4
ER -