University of Texas Medical Branch San Antonio, Texas, United States
Background/Case Studies: The Massive Transfusion Protocol (MTP) is a key procedure employed by physicians and hospital transfusion service departments to provide hemorrhaging patients with lifesaving blood products. Current studies mainly investigate the implementation of MTPs, but they do not address the possible knowledge gap among physicians on how to initiate and properly use the protocol. This study sought to identify how physicians from different specialties and hospital sizes behave during MTPs and how that may affect patient care and transfusion service resources. The goal was to evaluate the current behavior towards MTPs and to investigate potential related impacts including overutilization, waste, and nonstandard transfusion ratios.
Study
Design/Methods: The results reflect a retrospective analysis of 214 MTP cases from a transfusion services Department at a multi-campus academic medical center. The eligible MTP cases were divided by physician specialty (anesthesiology, emergency medicine, internal medicine, obstetrics/gynecology, surgery/other, and trauma surgery) and hospital size (small medium hospital (0-499 beds) and large hospital ( >=500 beds)). The data was used to determine the rate of MTP overutilization, product wastage, and transfusion ratio acceptability by physician specialty and hospital size.
Results/Findings: Our study did not show a difference among physician specialties in transfusion ratios (p=0.868) or utilization (p=0.208). All specialties had high rates ( >50%) of non-standard transfusion ratios and overutilization. Compared to large hospitals, small hospitals exhibited more overutilization (p=< 0.001) and inappropriate transfusion ratios. The data showed a difference between physician specialties in mean wastage of red blood cells (RBC) (p=0.006) and fresh frozen plasma (FFP) (p=0.003). Emergency Medicine wasted more RBCs per case than Anesthesiology (p=.027), Internal Medicine (p=< 0.001), Obstetrics/Gynecology (p=.004), Surgery (p=.006), and Trauma (p=< 0.001). Trauma Surgery wasted more FFPs per case on average compared to Emergency (p=0.05) and Internal Medicine (p=0.05). Large hospitals had a higher mean FFP wastage per case when compared to Small/Medium hospitals (p=< 0.001). Conclusions: MTP overutilization and nonstandard transfusion ratio use are prevalent and not dependent on physician specialty. Small-sized hospitals may overutilize MTPs and employ inappropriate transfusion ratios due to a lack of experience with the handling of MTPs. Overutilization and use of nonstandard transfusion ratios are taxing to the transfusion services resources and may place patient care on hold for other patients. Further studies are needed to investigate possible interventions to reduce overutilization and use of nonstandard transfusion ratios to minimize the impact on the transfusion service’s resources including blood product wastage.
