Reducing perioperative red blood cell unit issue orders, returns, and waste using failure modes and effects analysis

• Published in: Transfusion (Philadelphia, Pa.) Pa.), 2023-04, Vol.63 (4), p.755-762
• Main Authors: Lou, Sunny S., Dewey, Megan M., Bollini, Mara L., Harford, Derek R., Ingold, Cindy, Wildes, Troy S., Stevens, Tracey W., Martin, Jackie L., Grossman, Brenda J., Kangrga, Ivan
• Format: Article
• Language: English
• Subjects: Blood; Blood Banks; blood conservation; Blood Transfusion; Cost control; Costs; Erythrocyte Transfusion; Erythrocytes; Failure analysis; Failure modes; Health care facilities; Healthcare Failure Mode and Effect Analysis; Humans; Intervention; Labor; perioperative blood management; surgical transfusion practice; Transfusion
• ISSN: 0041-1132; 1537-2995
• DOI: 10.1111/trf.17275

Background Surgical transfusion has an outsized impact on hospital‐based transfusion services, leading to blood product waste and unnecessary costs. The objective of this study was to design and implement a streamlined, reliable process for perioperative blood issue ordering and delivery to reduce waste. Study Design and Methods To address the high rates of surgical blood issue requests and red blood cell (RBC) unit waste at a large academic medical center, a failure modes and effects analysis was used to systematically examine perioperative blood management practices. Based on identified failure modes (e.g., miscommunication, knowledge gaps), a multi‐component action plan was devised involving process changes, education, electronic clinical decision support, audit, and feedback. Changes in RBC unit issue requests, returns, waste, labor, and cost were measured pre‐ and post‐intervention. Results The number of perioperative RBC unit issue requests decreased from 358 per month (SD 24) pre‐intervention to 282 per month (SD 16) post‐intervention (p