Safe transition to surgery: working differently to make blood transfusion process safer for elective surgery

Authors

  • Karafa S.W. Badjie,

    Corresponding author
    1. Department of Laboratory Medicine and Pathology Division of Transfusion Medicine, Mayo Clinic, Rochester, Minnesota
    • Address reprint requests to: Karafa S.W. Badjie, MS, MLS (ASCP), SBB, MLT (CSMLS), Mayo Clinic, 200 First Street SW, Rochester, MN 55905; e-mail: Badjie.karafa@mayo.edu.

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  • James C. Rogers,

    1. Systems and Procedures, Mayo Clinic, Rochester, Minnesota
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  • Sarah M. Jenkins,

    1. Department of Health Sciences Research, Division of Biomedical Statistics & Informatics, Mayo Clinic, Rochester, Minnesota
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  • Kevin L. Bundy,

    1. Department of Laboratory Medicine and Pathology Division of Transfusion Medicine, Mayo Clinic, Rochester, Minnesota
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  • James R. Stubbs,

    1. Department of Laboratory Medicine and Pathology Division of Transfusion Medicine, Mayo Clinic, Rochester, Minnesota
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  • Robert R. Cima

    1. Department of Surgery, Mayo Clinic College of Medicine, Rochester, Minnesota
    2. Surgical Outcomes Program, Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota.
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Abstract

BACKGROUND

Our institutional policy allows patients who are scheduled for elective surgery with no history of a pregnancy or blood transfusion in the preceding 3 months to have a presurgical sample (PSS) collected and tested up to 56 days before their scheduled surgery; however, our PSS TS completion rate in eligible patients before the morning of surgery was 83%. In 2011, a team was charged to develop a standardized process along with other process improvements while ensuring no increase in transfusion-related events.

STUDY DESIGN AND METHODS

The team followed the DMAIC framework in appraising the effectiveness and efficiency of the current state process including baseline data collection such as PSS TS completion rate, number of eligible patients needing a PSS TS on the day of surgery, benchmarking, SSBO utilization, and future state mapping.

RESULTS

First quarter (Q1) 2011 versus Q1 2012 postimplementation results showed significant improvements of the process including a 53% decrease in PSS TS on the day of surgery; a 13% increase in PSS TS completion before the morning of surgery; a 26% reduction in total XM RBCs; and a 58.8% reduction in XM RBCs not issued, plus a 47% decrease in RBC wastage. Q1 2011 versus Q1 2013 showed a 41% reduction in total XM RBCs and an 88.4% reduction in XM RBCs not issued but overall RBCs issued versus returned increased slightly and represents a future opportunity for improvement.

CONCLUSIONS

The redesigned, transformational process eliminated SSBO and improved ordering process and PSS TS completion rate as well as blood product ordering and utilization.

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