Implementing structured handoffs to verify operating room blood delivery using a quality academy training program: an interrupted time-series analysis

Abstract

Background Blood transfusion is a complex process at risk for error. We aimed to implement a structured handoff during this process to improve delivery verification. Methods A multidisciplinary team participated in the Quality Academy training program at an academic medical center and implemented a structured handoff of blood delivery to the operating room using Plan-Do-Study-Act cycles between October 28, 2019 and December 1, 2019. An interrupted time series analysis was performed to investigate the proportions of verified deliveries (primary outcome) and of verified deliveries among those without a handoff (secondary outcome). Delivery duration was also assessed. Results A total of 2,606 deliveries occurred from July 1, 2019 to April 19, 2020. The baseline trend for verified deliveries was unchanging (parameter coefficient -0.0004, 95% CI -0.002 to 0.001; P=0.623). Following intervention, there was an immediate level change (parameter coefficient 0.115, 95% CI 0.053 to 0.176; P=0.001) without slope change (parameter coefficient 0.002, 95% CI -0.004 to 0.007; P=0.559). For the secondary outcome, there was no immediate level change (parameter coefficient -0.039, 95% CI -0.159 to 0.081; P=0.503) nor slope change (parameter coefficient 0.002, 95% CI -0.022 to 0.025; P=0.866). The mean (SD) delivery duration during the intervention was 12.4 (2.8) minutes, and during the post-intervention period 9.6 (1.6) minutes (mean difference 2.8, 95% CI 0.9 to 4.8, P=0.008). Conclusion Using the Quality Academy framework supported implementation of a structured handoff during blood delivery to the operating room, resulting in a significant increase in verified deliveries.