Background/Case Studies: Transfusion Services (TS) must be well-organized and efficient to be ready for large volume transfusion orders to meet the needs of complex surgical patients. In our hospital, a strategy was needed to align the TS with the goals of the institution due to the increasing volume of complex surgical cases. It became necessary to streamline the blood ordering process for cases needing blood components rapidly or when large number of blood components need to be on standby (see Table 1). A TS staff that is engaged, well-trained and competent is key. Clear lines of communication and expectations between the clinical teams and the TS must be established.
Study
Design/Methods: Creating and implementing tools for communication between the clinical team and the TS throughout a case, ensures that the blood ordering process is seamless, documents a complete timeline and helps the TS provide requested blood components in a timely manner. Starting in 2013 a simple Form named “Critical Transfusion Needs” was implemented. This allowed for documentation of notification of Emergency Release Requests of uncrossmatched red blood cells, Massive Transfusion Protocol (MTP) initiation and a cardiac surgery emergency declaration. In following years, other forms have been developed in collaboration from the clinical teams, describing components and procedures for each type of case as they were added to our clinical activities. The “OB MTP” Form has a different notification tree (including MFM and GYN surgery) from the point of transfusion service operator notification and an adjusted blood component ratio. The “Cardiac Transplant Notification” Form includes a breakdown of procedures (e.g., Primary Sternotomy, Redo Sternotomy, LVAD explant) detailing blood component ratios. The “Liver Transplant Notification” Form also indicates required ratios with instructions for blood bank techs to perform RBC phenotyping on pretransfusion specimen. The “Lung Transplant Notification” Form includes single lung, double lung and pre-op ECMO procedures and blood component requirements.
Results/Findings: All Forms include documentation of all communication between the TS and the clinical teams, additional products ordered and release time, case conclusion time and components returned at the end of the case. Conclusions: The TS must be proactive as the complexity of surgical cases evolve. Communicating with clinical teams, forecasting transfusion needs and setting up processes for the TS to succeed is critical. Incorporating the appropriate tools, providing education, ensuring competency and auditing turn-around times have proven successful in meeting blood order demands and ensuring that the transfusion service provides timely, safe and efficient services. Having a mechanism for real-time documentation allows the TS to be fully engaged in the patient’s safety and positive clinical outcomes.
Importance of research: Due to the large number of surgical cases performed, ensuring clear, documented communication is vital to the success of patient procedures. Our forms describe blood component requirements for each specific procedure, allow us to document all necessary information and have a clear picture of blood component usage from start to the end of the case. Our TS team knows exactly how each procedure is progressing with blood components which is vital to the successful delivery of required products.
