Department of Anesthesiology, Washington University School of Medicine, St Louis, Missouri, USA.
Transfusion Services, Barnes-Jewish Hospital, St Louis, Missouri, USA.
Transfusion. 2023 Apr;63(4):755-762. doi: 10.1111/trf.17275. Epub 2023 Feb 8.
Surgical transfusion has an outsized impact on hospital-based transfusion services, leading to blood product waste and unnecessary costs. The objective of this study was to design and implement a streamlined, reliable process for perioperative blood issue ordering and delivery to reduce waste.
To address the high rates of surgical blood issue requests and red blood cell (RBC) unit waste at a large academic medical center, a failure modes and effects analysis was used to systematically examine perioperative blood management practices. Based on identified failure modes (e.g., miscommunication, knowledge gaps), a multi-component action plan was devised involving process changes, education, electronic clinical decision support, audit, and feedback. Changes in RBC unit issue requests, returns, waste, labor, and cost were measured pre- and post-intervention.
The number of perioperative RBC unit issue requests decreased from 358 per month (SD 24) pre-intervention to 282 per month (SD 16) post-intervention (p < .001), resulting in an estimated savings of 8.9 h per month in blood bank staff labor. The issue-to-transfusion ratio decreased from 2.7 to 2.1 (p < .001). Perioperative RBC unit waste decreased from 4.5% of units issued pre-intervention to 0.8% of units issued post-intervention (p < .001), saving an estimated $148,543 in RBC unit acquisition costs and $546,093 in overhead costs per year.
Our intervention, designed based on a structured failure modes analysis, achieved sustained reductions in perioperative RBC unit issue orders, returns, and waste, with associated benefits for blood conservation and transfusion program costs.
手术输血对医院为基础的输血服务有重大影响，导致血液产品浪费和不必要的成本。本研究的目的是设计和实施一种简化、可靠的围手术期血液问题订购和交付流程，以减少浪费。
为了解决大型学术医疗中心手术血液问题请求和红细胞（RBC）单位浪费率高的问题，采用失效模式和影响分析（Failure Modes and Effects Analysis，FMEA）系统地检查围手术期血液管理实践。基于确定的失效模式（例如，沟通失误、知识差距），制定了一个多部分行动计划，包括流程更改、教育、电子临床决策支持、审核和反馈。在干预前后测量 RBC 单位问题请求、返回、浪费、劳动力和成本的变化。
围手术期 RBC 单位问题请求数量从干预前每月 358 个（SD 24）减少到每月 282 个（SD 16）（p <.001），估计每月节省血液银行工作人员 8.9 小时的劳动力。问题到输血的比例从 2.7 降至 2.1（p <.001）。围手术期 RBC 单位浪费从干预前发放单位的 4.5%降至干预后发放单位的 0.8%（p <.001），每年节省 RBC 单位购置成本约 148543 美元，间接成本约 546093 美元。
我们的干预措施基于结构化的失效模式分析设计，实现了围手术期 RBC 单位问题订单、返回和浪费的持续减少，同时也有利于血液保存和输血计划成本。
