Incomplete pretransfusion testing leads to surgical delays

Abstract

We identified three mechanisms by which delays in completing pretransfusion testing in surgical patients occurred. Adherence to the MSBOS and sample collection policies should reduce delays.

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

“…Although we did not specifically assess these occurrences, by clearly defining ahead of time the need for blood orders, these new guidelines should decrease the number of surgical cases that do not have blood available before the surgical start time, a practice not in compliance with The Joint Commission guidelines. 23 Thus, the MSBOS may also decrease delays in starting surgical cases, 24 decrease excess ordering of laboratory tests, 18 and promote the goals of patient blood management programs.…”

How we manage AB plasma inventory in the blood center and transfusion service

“…While some of the situations in which emergency‐issued group AB plasma is used in the operating room cannot be avoided due to the unexpected complexity or urgency of the case, the use of group AB plasma in this manner could likely have been avoided if the clinical team had adhered to the recommendations for pretransfusion testing in the institution's type‐and‐screen protocol and/or maximum surgical blood ordering schedule (MSBOS) . Observational data from two of the authors (KJL and MHY) of hospitals served by their blood centers suggests that, unfortunately, the usage of formalized type‐and‐screen protocols and MSBOS to reduce unnecessary blood component orders may not be as prevalent as perceived in some regions of the United States.…”

A novel approach to improving efficiency and cost saving in preoperative blood preparation

“…After the storage interval was increased to 14 days, the median number of exT&Ss performed increased by a median of 37 samples per month (range, 25‐61), with no significant change in surgical volume per month. Assuming a T&S charge is between $75 and $100 with a median of $87.50, potential savings totaled $38,770 per year ($22,420‐$73,120). Further varying monthly volumes by decreasing the number of redrawn specimens by 50% to 75% still showed annual savings with a range from $11,170 to $54,820 (Table , Fig.…”

“…The College of American Pathologists conducted a survey examining the timing of completion of T&S. Of 8941 T&Ss, 64.6% were collected the day of surgery and, of these, 23% were completed after the start of surgery . Proceeding before completion of T&S testing can lead to up to a 12‐hour delay before starting surgery or worse if surgery is started and blood is not available. Due to compromised patient safety, some institutions have incorporated the T&S status into their surgical safety checklist .…”