Background Reducing unnecessary preparation of blood components decreases cost and improves value. Standard surgical blood order schedules (SSBOS), which make recommendations on which procedures require a type and screen (T and S), have been shown to help reduce variability and improve patient safety. We explore how evidence-based interventions preoperatively optimise the process.
Objectives Our aim was to standardise the process and implement an evidence-based process improvement to reduce unnecessary T and S samples for laparoscopic hysterectomy cases.
Methods After IRB approval, we reviewed data from January 2014 to February 2016. Outcomes followed were: 1) T and S samples and 2) blood transfusion rates. Interventions were: 1) termination of routine ordering of T and S samples by pre-anaesthesia evaluation team (4/2015); and 2) implementation of a SSBOS guideline within a new EHR system (4/2016). We used statistical process control and descriptive statistics for analysis.
Results At baseline, of 615 laparoscopic hysterectomy procedures, T and S obtained for 490 procedures (78%), 21 patients (3%) received at least 1 unit of blood. Of 490 procedures after Intervention-1, T and S obtained for 300 cases (61%), 18 patients (3%) received transfusion. Of 552 procedures after Intervention-2, T and S obtained for 144 cases (21%), 5 patients (1%) received transfusion (Table 1). Figure-1 shows a process control chart plotting the T and S samples over time with interventions at 5–2015 and 4–2016 which show a significant decrease in mean T and S samples.
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