136: The Other End: Evaluation of Blood Bank Technologists and Hematologists During a Massive Hemorrhage Simulation Project

Abstract

Background: Massive hemorrhages (MH) are life-threatening complications of trauma and obstetrical cases. Expertise and effective communication is key among all team members involved. Collaboration with blood bank technologists (BBT) and hematologists assisting teams with prompt preparation and delivery of blood products further contributes to optimizing care. Objectives: To evaluate communication and expertise when preparing and delivering blood products during MH cases using in situ simulation. Design/Methods: Prospective observational study held at a blood bank (BB) and simlab of a tertiary care facility. Participants were BBTs and hematologists and pediatric emergency/critical care and obstetrical/anesthesia teams submitted to high fidelity (HF) simulated pediatric trauma and post-partum MH scenarios, respectively. BBT were videotaped at the BB and conversations with teams at the simlab were recorded. If hematologists were consulted, the chief BBT questioned them on issues relevant to MH.BBT were evaluated by a blinded trained independent rater using a checklist rating expertise and key communication skills necessary when preparing and delivering blood products to teams involved in MH. Hematologists were rated using a questionnaire exploring their ability to assist and communicate with BBTs and clinicians dealing with choosing blood products or compatibility issues. Means and SDs of scores on checklists and questionnaires were calculated. Results: Participants were eight BBT, eight hematologists and 62 healthcare professionals involved in eight interdisciplinary teams (four obstetrics/anaesthesia and four pediatric emergency/critical care). BBT scored on average 78% (61% to 92%) and 76%(62% to 100%) in expertise and communication checklists (trauma and post-partum simulations, respectively). Hematologists rightly refused blood specimens to determine blood type in 57% (four of seven) (discrepant ABO/Rh blood group with previous ABO group results).Their ability to choose or substitute blood products was observed in 71% (five of seven).When challenged by the fact that an incompatible blood product was delivered to the patient, 37.5% (three of eight) asked for phenotype analysis of products already transfused and those being prepared and no one advised teams or of the possibility of a hemolytic transfusion reaction. Conclusions: BBT were considered relatively ready and possess necessary expertise and communication skills to prepare and deliver blood products to teams dealing with MH. For hematologists, knowledge gaps were identified and additional training is mandatory to ensure proficiency when assisting teams with such emergencies. Using in situ simulation at the BB and hematologists in addition to HF interdisciplinary team simulations at a simlab can further add to improving performances of all professionals actively involved in MH crisis situations.