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1050 Decreasing unnecessary blood bank testing for laparoscopic hysterectomy
  1. Anne Que,
  2. Aalok Agarwala
  1. Massachusetts General Hospital, Department of Anaesthesia, Critical Care and Pain Medicine, US

Abstract

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.

Abstract 1050 Table 1

Conclusions Unnecessary preparation of blood products for operations with historically low rates of transfusion represents wasted phlebotomy, labour, and expense. Using laparoscopic hysterectomy as an example, we decreased unnecessary T and S using data to guide pre-operative testing.

Abstract 1050 Figure 1

Percentage of type and screen drawn for laparoscopic hysterectomy procedure p chart, sigma

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