Optimizing the provision of blood for neonatal exchange transfusions

Abstract

Background/Case Studies: Neonatal exchange transfusions require "reconstituted" whole blood (RWB) derived from red blood cell (RBC) and group AB fresh frozen plasma (FFP) units mixed to a target product hematocrit (Hct) of 40% to 60%. In our region, the community blood center (BC) manufactures RWB for most hospitals having neonatology services (NS). In July 2014, we encountered a case in which order-to-shipment (OTS) BC turnaround time (TAT) was unacceptably delayed (6 hours, 8 minutes). Although the patient's outcome was not compromised, the prolonged TAT prompted BC and local academic medical center (AMC) staffs to identify and correct process inefficiencies. Herein, we describe modifications made to BC processes. Study Design/Methods: BC and AMC staffs worked collaboratively to identify and correct all potential barriers to the timely manufacture and provision of RWB units. BC staff then analyzed relevant RWB data from before and after corrective actions. Results/Findings: On January 5, 2015, we implemented the following changes: 1) The transfusion service (TS), neonatal service (NS), and BC staffs standardized the targeted RWB Hct to 40%- 50%; 2) the TS and BC streamlined the RWB-ordering process; 3) the BC eliminated (a) pre-reconstitution Hct testing of RBC units and (b) the requirement that RWB Hct testing be performed only by licensed staff; 4) The BC required that (a) staff prioritize RWB orders as "priority 1," (b) a consistent supply of group AB FFP be stored in an easily accessed location, and (c) the FFP thawer always be set to the required temperature; and 5) The BC modified staffing of component manufacturing area to support 24/7 readiness for RWB orders. Last, BC staff members are now required to contact the on-duty physician immediately when RWB order complications occur, thereby allowing for rapid problem resolution. The Table summarizes relevant BC data before and after the corrective actions. Conclusion: Through collaboration, the BC and AMC staffs identified and corrected system inefficiencies, improved TATs for RWB orders, and retained acceptable product Hcts. Early TAT results are encouraging. We will continue monitoring the parameters to determine statistical significance and to make modifications to our BC processes as necessary. (Table Presented).