Impacts of Updated Transfusion Guidelines on a Small Hospital Blood Bank in a Chicago Suburb

Abstract

The purpose of this research was to identify effective means to utilize blood product resources within a hospital laboratory. A retrospective review of six years of blood utilization data (2010-2015) was analyzed from Rush Oak Park Hospital, Oak Park, IL, a small hospital blood bank in a suburb of Chicago. Time-frames included: before electronic medical record (EMR) use: after EMR implementation and computerized provider order entry (CPOE) use: and following targeted physician education. Updated transfusion indications were implemented in time-frame three in an effort to reduce unnecessary crossmatch and transfusion orders, and improve patient safety. The mean number of crossmatched and transfused units decreased significantly from time-frame two to three: from 236±44 units crossmatched to 166±29 units (p <0.001) and 154±31 units to 99±18 units transfused (p<0.001). The blood type and antibody screen (T/S) samples increased significantly over the same period (p<0.03). Surgical and emergency room (ER) crossmatch to transfusion ratios (C:T) showed no significant change, while the other category (inpatient, outpatient, and Hematology/Oncology clinic) revealed a significant increase over time-frames two to three (p<0.001). The number of red blood cell (RBC) units transfused from 2013 to 2014 declined by 646 units, with an estimated cost savings of $129,200. Providing evidence-based guidelines with CPOE to reduce ordering and preparation of blood products is an area of opportunity to improve care and reduce costs.

ABBREVIATIONS: EMR - electronic medical record; CPOE = computerized provider order entry; MSBOS - maximum surgical blood order schedule; T/S - blood type and antibody screen; ER - emergency room; C:T - crossmatch to transfusion ratio; RBC - red blood cell; ANOVA - analysis of variance