Background/Case Studies: Hospital transfusion services perform pretransfusion testing in order to provide life-saving transfusions to patients as safely as possible. This relies not only on proper recipient identification and sample collection, but also sufficient time for completion of serologic testing. In emergent situations, uncrossmatched, group O positive/negative red blood cell units will be released from the hospital transfusion service posing an increased risk to the patient and inventory constraints. An institutional quality assessment was performed to determine if type and screen (TASR) samples could have been drawn prior to patients entering the operating rooms (OR) and what impact this would have on patient care and blood bank inventory.
Study
Design/Methods: A retrospective chart review of all TASRs ordered from the OR between January – June 2022 was performed and analyzed for the following parameters: time interval between order placement in the OR and last patient encounter with the surgeon/surgical service, most recent blood draw collected from the patient (regardless of indication), average presurgical hemoglobin value, ordering service and surgical indications.
Results/Findings: Nine hundred and seventy-seven patients had TASRs ordered from the OR and of these, 149 were transfused. Of these 149 patients, our review revealed the following: 31 were issued uncrossmatched red blood cells for a total of 44 units (33 O positive, 6 O negative), 119 (79.9%) patients were seen by the surgeon/surgical service at least one day prior to the surgical procedure and 119 (79.9%) patients had a laboratory specimen collected at least one day prior to their surgical procedure. The average turnaround time for TASR results from time of order was one hour and six minutes. An additional analysis on 400 randomly selected patients from this cohort (not-transfused n=310; transfused, n=90; data analyzed with an unpaired Mann-Whitney test) revealed a median hemoglobin of 10.8 g/dL vs 12.8 g/dL in transfused vs non-transfused patients (p < 0.0001). Conclusions: These results indicate that collection of TASR samples prior to surgery will decrease the release of uncrossmatched red blood cell units while simultaneously mitigating the impact on our group O inventory. Opportunities exist to collect patient samples prior to patients entering the operating theater and is now the subject of a quality improvement project with realistic goals of practice modifications. Of note, we had multiple secondary findings including the observation that there was a statistically significant difference in presurgical hemoglobin values in transfused and non-transfused patients; this, coupled with other observations not reported here, have the added potential to inform pre-surgical testing recommendations.
Importance of research: In order to ensure the safety of patients receiving blood products, it is vital that hospital transfusion laboratories have sufficient time to complete pretransfusion testing. Collecting type and screen orders before patients are in the operating theater is an important step to improve the quality of care, improve the workflow in the hospital transfusion laboratory, and decrease risks associated with transfusing uncrossmatched red blood cell units.
