Seattle Children's Hospital Seattle, Washington, United States
Background/Case Studies: The Transfusion Service laboratory staff escalated a significant issue with unnecessary blood bank hold (BBhold) orders. Data analysis showed that 10% of all transfusion service specimens were BBhold, indicating inefficiencies in specimen ordering and impact on patient care. The indication for the specimen order, BBHold, is for patients needing extra specimens for compatibility testing; however, ordering practice expanded beyond this primary indication. Evaluation of data and observed trends revealed the need for interventions to improve ordering processes, including addressing duplicate orders, avoiding hold orders when transfusion is uncertain, and increasing the visibility of recent type and screen results. Given the critical role of blood bank specimens in patient care, addressing this issue improves efficiency and reduces unnecessary phlebotomy. The outcome measure of this quality improvement (QI) project targeted a reduction of overall BBHold specimens by >50% in one year.
Study
Design/Methods: This prospective and longitudinal design QI project adopted a systematic approach using plan-do-study-act (PDSA). Data from the blood bank information system and the electronic health record (EHR) informed the baseline assessment and provided metrics for each PDSA cycle. Interventions, such as educating healthcare providers (PDSA cycle #1), removing default BBHold selections in EHR orders (PDSA cycle #2), implementing EHR alerts (PDSA cycle #3), and enhancing type and screen result and expiration date and time visibility (PDSA cycle #4), were developed based on baseline findings and stakeholder input. Each intervention was implemented gradually with collaboration from stakeholders, aiming for a meaningful impact on the overall quantity of BBHold orders.
Results/Findings: After the initial PDSA cycles, BBHold samples dropped by 50%, as noted in Figure A. Subsequent cycles reduced BBHold to 4.8% and further to 2.8%, with enhanced order and result visibility. The 6-month BBHold average is 3.6%, achieving a >50% reduction. Conclusions: The targeted interventions implemented in this quality improvement project successfully optimized BBHold and transfusion sample orders. Specifically, addressing duplicate orders and enhancing order visibility reduced the quantity of unnecessary specimens collected. The outcome, surpassing the goal of reducing overall BBHold specimens by more than 50% in just one year, underscores the effectiveness of PDSA cycles. This improvement enhances efficiency in the transfusion service laboratory and contributes to better patient care by minimizing unnecessary phlebotomy procedures.
