Baylor College of Medicine/Harris Health System Houston, Texas, United States
Background/Case Studies: While blood transfusion in pre-hospital settings is not a new concept, it is becoming more and more common for private EMS helicopters and ambulances to carry blood. The task of ensuring pre-hospital transfusion documentation is essential for patient care as well as safety and regulatory satisfactions. However, documenting these pre-hospital transfusion within the hospital system can be difficult. Commonly encountered obstacles include determining the different local EMS services that carry blood, ensuring proper handoff from EMS to hospital staff, and requesting ED staff to document pre-hospital transfusion during times of staffing shortages and overflowing ED. In our case, setting up the IT infrastructure was the solution.
Study
Design/Methods: We first obtained a list of EMS services which carry blood for pre-hospital transfusion from our regional blood center. Then medical directors of those EMS services were contacted with requests for providing transfusion related information to hospital staff. With the endorsement of hospital administration, a work group including epic IT support, ED nursing staff, and transfusion medicine pathologists were formed to design an EPIC module to document this information electronically. When patient arrives to the ED with EMS currently infusing or completed infusion for blood/blood products, ED nurse will document the relevant information in Epic EMS blood section. It consists of 4 subsections. (See Figure)
Results/Findings: All required information is displayed in one page in EPIC, which is easy to navigate. The information captured is not much different from a regular blood transfusion except for 3 additional questions regarding EMS identifying information. With increasing awareness of the accountability and ensuring safety of blood transfusion, we did not encounter significant resistance from ED nursing staff for this documentation requirement. Conclusions: While pre-hospital transfusion is a low frequency event currently, it presents a high-risk scenario for the hospital as the blood bank and hospital staff may not be aware of the transfusion. By leveraging technology, we have implemented a documentation process for pre-hospital blood transfusion. This EPIC solution enhance patient safety, improves clinical and laboratory decision making, and ensures compliance with regulations.
Importance of research: Pre-hospital resuscitation with transfusion en route to the hospital is increasing in frequency across the United States and represents a potential gap in awareness of exposure to and documentation of blood products. We present an easily adopted solution that provides ease of use as well as access to data in the event of adverse events or lookbacks.
