360 Improved Timeliness of Emergency Blood Release: An Interdisciplinary Collaboration

Abstract

Introduction: Management of acute blood loss occasionally requires the expedient release of blood products to maintain hemodynamic stability before complete pretransfusion laboratory testing can be completed. We received clinician complaints over perceived delay in the emergent release of product from the blood bank. Our facility is an independent community hospital, and the laboratory is staffed primarily by generalists. In our investigation we discovered an opportunity for the education of providers at all levels in the existence and application of emergency blood product procedures. Methods: We began tracking the turnaround time (TAT) from request for product to the time of release with a goal of <10 minutes. Our first target for intervention was the laboratory. The blood bank supervisor created a decision tree to aid the generalist in quick and appropriate decision making. Brief didactic sessions were held during shiftchange huddles, and unannounced simulations of emergency situations were held sporadically. Our second target was nursing and clinical staff. Online learning modules centered on bedside processes were created in collaboration with nurse educators and were assigned to all registered nurses. Laboratory technical staff also completed the modules to aid in understanding of interdisciplinary processes. Nursing educators routinely quizzed floor nursing staff. A flowchart detailing emergency release and mass transfusion procedures was created and copies placed in all patient care areas. The medical staff was educated through grand rounds and at medical staff meetings. Conclusion: The incident event had a TAT of 27 minutes. Following the laboratory interventions, the average TAT decreased 68% to 8.5 minutes (n = 9). A further drop of 20% to 6.8 minutes was seen after the nursing interventions (n = 6). We attribute the success to increased understanding of existing procedures and, in particular, interdisciplinary collaboration, which allowed for more efficient communication during stressful situations.