NYC H+H/Bellevue & NYU Grossman School of Medicine New York, New York, United States
Background/Case Studies: Historically the hospital transfusion services within our system operated independently with little central oversight.Blood shortages, the need for cost saving, and the desire to improve the standard of care led to increased scrutiny.In 2022 we worked with our blood supplier and the individual hospital transfusion services to improve inventory management practices by adjusting the standing orders to more accurately reflect actual usage and to assure that the necessary blood products were already in inventory when clinically needed.We aimed to have a greater percentage of our blood products delivered on standing orders thereby reducing the number of emergency and supplemental delivery orders which entail added costs.
Study
Design/Methods: The number of emergency and supplemental blood product deliveries in 2023 were compared to those in 2020 to assess the impact of the changes made to our standing orders.Total blood product purchases and discards in 2020 and 2023 were also evaluated to gauge any unintended consequences.Results were assessed using the Student’s T-test.
Results/Findings: 59% of blood products were delivered on a standing order in 2020 which increased to 69.4% in 2023. 27% of blood products were delivered via emergency delivery in 2020 which decreased to 16.2% in 2023.The percent of products delivered as supplemental remained essentially the same at 14% in 2020 and 14.4% in 2023.Deliveries, purchases, and discards in 2020 and 2023 are seen in Table 1. There was no statistical difference in RBC purchases between 2020 and 2023 (p-value 0.19).Statistically more single donor platelets (SDPs) (p-value 0.035) and plasmas (p-value 0.003) were purchased in 2020 than in 2023.Statistically fewer RBCs (p-value 0.04) and SDPs (p-value 0.006) were purchased in 2023 than 2020. There was no statistical difference in the number of plasmas purchased between 2020 and 2023 (p-value 0.54).In 2020 there were 2267 emergency deliveries and 2136 in 2023 (p-value 0.37).In 2020 there were 1229 supplemental deliveries and 902 in 2023 (p-value 0.00005).Emergency delivery fees in 2020 were $316,947 and in 2023 were $311,109.Supplemental delivery fees in 2020 were $86,212 and in 2023 were $66,162. Conclusions: Aligning the standing orders to reflect actual usage resulted in 10% more blood products being delivered as part of a standing order and 10.8% less being delivered as emergency.The number of emergency deliveries however did not decrease as much as expected and consequently the expected saving was not achieved. The number of supplemental deliveries decreased significantly despite the percentage of products being delivered as supplemental remaining constant.
