Blood ordering from the operating room: turnaround time as a quality indicator

Authors

  • Colt M. McClain,

    1. From the Department of Veterans Affairs Medical Center, Nashville, Tennessee; the Departments of Pathology, Microbiology and Immunology, Internal Medicine, and Anesthesiology, Vanderbilt University Medical Center, Nashville, Tennessee; and the Departments of Pathology and Medicine, Stanford University Medical Center, Stanford, California.
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  • Jonathan Hughes,

    1. From the Department of Veterans Affairs Medical Center, Nashville, Tennessee; the Departments of Pathology, Microbiology and Immunology, Internal Medicine, and Anesthesiology, Vanderbilt University Medical Center, Nashville, Tennessee; and the Departments of Pathology and Medicine, Stanford University Medical Center, Stanford, California.
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  • Jennifer C. Andrews,

    1. From the Department of Veterans Affairs Medical Center, Nashville, Tennessee; the Departments of Pathology, Microbiology and Immunology, Internal Medicine, and Anesthesiology, Vanderbilt University Medical Center, Nashville, Tennessee; and the Departments of Pathology and Medicine, Stanford University Medical Center, Stanford, California.
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  • Jennifer Blackburn,

    1. From the Department of Veterans Affairs Medical Center, Nashville, Tennessee; the Departments of Pathology, Microbiology and Immunology, Internal Medicine, and Anesthesiology, Vanderbilt University Medical Center, Nashville, Tennessee; and the Departments of Pathology and Medicine, Stanford University Medical Center, Stanford, California.
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  • Stephanie Sephel,

    1. From the Department of Veterans Affairs Medical Center, Nashville, Tennessee; the Departments of Pathology, Microbiology and Immunology, Internal Medicine, and Anesthesiology, Vanderbilt University Medical Center, Nashville, Tennessee; and the Departments of Pathology and Medicine, Stanford University Medical Center, Stanford, California.
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  • Dan France,

    1. From the Department of Veterans Affairs Medical Center, Nashville, Tennessee; the Departments of Pathology, Microbiology and Immunology, Internal Medicine, and Anesthesiology, Vanderbilt University Medical Center, Nashville, Tennessee; and the Departments of Pathology and Medicine, Stanford University Medical Center, Stanford, California.
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  • Maurene Viele,

    1. From the Department of Veterans Affairs Medical Center, Nashville, Tennessee; the Departments of Pathology, Microbiology and Immunology, Internal Medicine, and Anesthesiology, Vanderbilt University Medical Center, Nashville, Tennessee; and the Departments of Pathology and Medicine, Stanford University Medical Center, Stanford, California.
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  • Lawrence T. Goodnough,

    1. From the Department of Veterans Affairs Medical Center, Nashville, Tennessee; the Departments of Pathology, Microbiology and Immunology, Internal Medicine, and Anesthesiology, Vanderbilt University Medical Center, Nashville, Tennessee; and the Departments of Pathology and Medicine, Stanford University Medical Center, Stanford, California.
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  • Pampee P. Young

    Corresponding author
    1. From the Department of Veterans Affairs Medical Center, Nashville, Tennessee; the Departments of Pathology, Microbiology and Immunology, Internal Medicine, and Anesthesiology, Vanderbilt University Medical Center, Nashville, Tennessee; and the Departments of Pathology and Medicine, Stanford University Medical Center, Stanford, California.
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Pampee Young, Department of Pathology, Vanderbilt University School of Medicine, 1161 21 Avenue South, C2217A MCN, Nashville, TN 37232 ; e-mail: pampee.young@vanderbilt.edu.

Abstract

BACKGROUND: Quality indicators in transfusion medicine are necessary for patient safety and customer satisfaction. The turnaround time (TAT) of issuing red blood cells (RBCs) has emerged as a quality indicator but is not an established benchmark. We examined the TAT for issuing RBCs from the blood bank to the operating rooms (ORs) at Vanderbilt University Medical Center (VUMC) and Stanford University Medical Center (SUMC).

STUDY DESIGN AND METHODS: TAT was defined from time of request to when RBCs exited the blood bank. Cases eligible for analysis had completed type-and-screen results with requests for four or fewer RBC units. Patients with a positive antibody screen had serologically crossmatched units prepared and reserved for intraoperative use. We also e-mailed surveys to academic institutions to establish the current state of TAT monitoring and to anesthesiologists at VUMC to gauge the TAT expectations of the OR.

RESULTS: The mean TATs at the two institutions were comparable (VUMC, 10 ± 3.8 min; SUMC, 14 ± 7.2 min) for orders of RBCs. The most common reasons for delayed TAT were overlapping orders, medical technologists occupied by phone calls, and oversaturation of pneumatic tube stations. Only 3 of 24 surveyed institutions actively monitored RBC TAT. Surveyed anesthesiologists (n = 7) reported an expectation for RBC TAT of 5 to 15 minutes for urgent cases. Established internal TAT policies were 15 and 20 minutes at VUMC and SUMC, respectively, for crossmatched RBC requests for patients with complete diagnostic testing.

CONCLUSION: Many of the surveyed institutions do not monitor stat RBC issue TAT as a quality indicator. This study serves as a starting point for establishing a benchmark for TAT for issuing RBCs from the blood bank to ORs.

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