(P-TS-96) Type O RBC Inventory Management Can Be Significantly Improved Via Active Monitoring, Data Sharing, and Collaboration

Background/Case Studies: Our system has struggled to balance the ease of stocking O-positive (O-pos) and O-negative (O-neg) RBCs with the need to better stewards of the community blood supply. Given our system’s large size and annual transfusion (Txn) volume, even purchasing O RBCs at a slightly higher percentage than other hospitals can exacerbate shortages. Although we previously attempted to better align the ABORh mix of our RBC purchases with the ABORh requirements of our patients, shortages due to Covid-19 required action to preserve the limited type O RBCs. In 2020 we implemented active monitoring of the ABORh of RBCs being transfused (Txed) to patients by their ABORh type, shared inventory data via a daily dashboard, and worked with our Txn services and blood supplier to alter standing orders to assure a more normal ABORh type mix. We sought to assess the impact of these changes on our type O RBC inventory management.

Study

Design/Methods: Annual inventory and Txns from 2022 were compared to those from 2019. The percentages of O-pos and O-neg RBCs Txed by hospital were calculated. Results were assessed using the Student’s T-test.

Results/Findings: Our system’s RBCs inventory increased from 39575 in 2019 to 45281 in 2022 (p-value < 0.02). Our system Txed 36870 RBCs of which 20338 were O-pos and 5068 were O-neg in 2019 and 43183 RBCs of which 21898 were O-pos and 5030 were O-neg in 2022. 2227 more patients were Txed in 2022 than 2019 (12637 vs 10410). 1753 RBCs were discarded in 2019 and 1977 in 2022 (p-value < 0.005). Table 1 shows the percentages of type O RBCs Txed. In 2019 55.2% of Txed RBCs were O-pos and 13.7% were O-neg. By 2022 that decreased to 50.7% O-pos and 11.6% O-neg (p-values < 0.05 and < 0.007, respectively). The percent of O-pos RBCs Txed to non-O-pos patients decreased from 11% in 2019 to 7.1% in 2022 (p-value < 0.003) and of O-neg to non-O-neg from 10.1% to 8.5%. 3240 RBCs in 2019 and 4238 RBCs in 2022 were Txed via emergency issue (EI). When RBCs Txed via EI were excluded, the percent of O-pos RBCs Txed to non-O-pos patients decreased from 8.2% in 2019 to 3.5% (p-value < 0.004) and O-neg to non-O-neg decreased from 7.3% to 3.2% (p-value < 0.03).

Conclusions: With the right motivations and tools, Txn services can change longstanding inventory management practices. Despite transfusing statistically more RBCs (p-value < 0.01) and patients in 2022 than 2019, 38 fewer O-neg RBCs were Txed. Had we not altered our practices, we would have Txed 1944 more O-pos and 907 more O-neg RBCs. Reducing unnecessary use of O-pos and O-neg RBCs helps to ensure that they are available when needed.

Importance of research: Although it is easy for a transfusion service to manage its inventory when it purchases type O RBCs which can be transfused to almost any patient, it is very challenging to collect an ample supply of type O RBCs. Transfusion services need to play an active roll in assuring an adequate blood supply. We have demonstrated that active monitoring, data sharing, and collaboration can result in significantly improved inventory management practices and can help to preserve the community blood supply.