Departments of Anesthesiology, Systems and Procedures, and Laboratory Medicine and Pathology, Division of Transfusion Medicine, Mayo Clinic, Rochester, Minnesota.
Transfusion. 2014 Mar;54(3):701-7. doi: 10.1111/trf.12315. Epub 2013 Jun 30.
The national waste rate for hospital-issued blood products ranges from 0% to 6%, with operating room-responsible waste representing up to 70% of total hospital waste. A common reason for blood product waste is inadequate intraoperative storage.
Our transfusion service database was used to quantify and categorize red blood cell (RBC) and fresh-frozen plasma (FFP) units issued for intraoperative transfusion that were wasted over a 27-month period. Two cohorts were created: 1) before implementation of a blood transport and storage initiative (BTSI)-RBC and plasma waste January 1, 2011-May 31, 2012; 2) after implementation of BTSI-RBC and plasma waste June 1, 2012, to March 31, 2013. The BTSI replaced existing storage coolers (8-hr coolant life span with temperature range of 1-10°C) with a cooler that had a coolant life span of 18 hours and a temperature range of 1 to 6°C and included an improved educational cooler placard and an alert mechanism in the electronic health record. Monthly median RBC and plasma waste and its associated cost were the primary outcomes.
An intraoperative BTSI significantly reduced median monthly RBC (1.3% vs. 0.07%) and FFP (0.4% vs. 0%) waste and its associated institutional cost. The majority of blood product waste was due to an unacceptable temperature of unused returned blood products.
An intraoperative BTSI significantly reduced median monthly RBC and FFP waste. The cost to implement this initiative was small, resulting in a significant estimated return on investment that may be reproducible in institutions other than ours.
医院发放的血液制品的全国浪费率在 0%到 6%之间，手术室负责的浪费占总医院废物的 70%。血液制品浪费的一个常见原因是术中储存不当。
我们使用输血服务数据库来量化和分类在 27 个月期间因术中输血而浪费的发放的红细胞（RBC）和新鲜冷冻血浆（FFP）单位。创建了两个队列：1）在实施血液运输和储存倡议（BTSI）之前-RBC 和血浆废物 2011 年 1 月 1 日至 2012 年 5 月 31 日；2）在实施 BTSI 后-RBC 和血浆废物 2012 年 6 月 1 日至 2013 年 3 月 31 日。BTSI 用具有 18 小时冷却剂寿命和 1 至 6°C 温度范围的冷却器替代了现有的储存冷却器（8 小时冷却剂寿命，温度范围为 1-10°C），并包括改进的教育冷却器挂牌和电子病历中的警报机制。每月中位数 RBC 和血浆废物及其相关成本是主要结果。
术中 BTSI 显着降低了每月中位数 RBC（1.3%对 0.07%）和 FFP（0.4%对 0%）废物及其相关的机构成本。大部分血液制品浪费是由于未使用的返回血液制品的温度不可接受。
术中 BTSI 显着降低了每月中位数 RBC 和 FFP 废物。实施这项倡议的成本很小，导致了可观的投资回报估计，这在我们之外的机构可能具有可复制性。
