Burk Camden, Eliason Kent, Doney Allison, Mountjoy Jeremi, Dalia Adam A
Department of Anesthesia, Critical Care, and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Boston, MA, 02114, USA.
Department of Pathology, Blood Transfusion Medicine, Massachusetts General Hospital, Boston, MA, USA.
J Med Syst. 2021 Feb 10;45(3):37. doi: 10.1007/s10916-021-01719-6.
Improvement of operating room efficiency regarding perioperative blood product transfusion is fundamental for surgical patients. The aim of this study was to 1) assess the use of cryoprecipitate in the operating room at our institution 2) identify and address gaps in knowledge regarding the process of ordering and returning cryoprecipitate 3) aim to reduce cryoprecipitate wastage by 50% over a 14-month period. Institutional data from Dec. 2017 to April 2020 was retrieved on cryoprecipitate that was ordered, thawed, and delivered to the operating room. Additionally, data was collected regarding cryoprecipitate that was wasted. A retrospective analysis of weekly intraoperative cryoprecipitate utilization was performed to compare wastage before and after implementation of interventions. Pre-intervention (Dec 2017 - March 2019), a total of 453 units of cryoprecipitate were issued with 14 units wasted (3% wastage). Between March 2019 and April 2020, the 14 months after our intervention, there were 402 units of cryoprecipitate issued with only 1 unit wasted (0.25% wastage). The overall cryoprecipitate waste rate was reduced by 91.66%. Month-to-month comparison of pre-intervention and post-intervention data identified significant reduction in average monthly wastage (0.875 vs 0.071 units respectively, p < 0.05). Appropriately, there was not a significant change in the mean monthly cryoprecipitate issued to the operating room (28.31 vs. 28.7 units, p = 0.94). These results demonstrate that utilizing educational initiatives for optimization of blood product management can reduce unnecessary ordering, transfusions, and wastage; an outcome that could ultimately reduce costs.
提高围手术期血液制品输注的手术室效率对手术患者至关重要。本研究的目的是：1）评估我院手术室冷沉淀的使用情况；2）识别并解决在冷沉淀订购和归还流程方面的知识差距；3）目标是在14个月内将冷沉淀浪费量减少50%。检索了2017年12月至2020年4月期间我院关于订购、解冻并送至手术室的冷沉淀的机构数据。此外，还收集了关于浪费的冷沉淀的数据。对每周术中冷沉淀使用情况进行回顾性分析，以比较干预措施实施前后的浪费情况。干预前（2017年12月至2019年3月），共发放453单位冷沉淀，其中14单位被浪费（浪费率3%）。在2019年3月至2020年4月，即我们干预后的14个月里，发放了402单位冷沉淀，仅1单位被浪费（浪费率0.25%）。冷沉淀总体浪费率降低了91.66%。干预前后数据的逐月比较显示平均每月浪费量显著减少（分别为0.875单位和0.071单位，p<0.05）。相应地，发放至手术室的冷沉淀月均值没有显著变化（28.31单位对28.7单位，p = 0.94）。这些结果表明，利用教育举措优化血液制品管理可减少不必要的订购、输血和浪费；这一结果最终可降低成本。
