Feinberg School of Medicine, Northwestern University Chicago, Illinois, United States
Background/Case Studies: Transfusion services are a core component of hospital operations and patient care. Technology is integrated into transfusion service operations with widespread use of laboratory information systems, electronic medical records and the electronic crossmatch.Literature on transfusion medicine experience and best practices during extended downtime is limited.
Study
Design/Methods: In January 2024, a US urban pediatric academic medical center experienced an extended information-system downtime period, 30 days. Downtime policies and procedures were implemented. Blood bank operations including blood utilization, compatibility testing, blood product modification, and transfusion reactions were assessed.
Results/Findings: A backup record of patient blood types, RBC antibody history and transfusion reaction history as of the downtime onset was available for reference.Blood bank adhered to AABB standards and regulatory requirements. Two unique patient identifiers linked downtime patient pseudonyms to historical blood bank records. Test tube or gel method type and screen identified four new RBC antibodies (anti-D, anti-E, anti-M and anti-Jsa).RBC units were issued with immediate spin crossmatch (no antibody history) or Coombs crossmatch (antibody history). Blood bank dispensed 545 RBC units, 211 platelet units, 83 plasma units and 41 cryoprecipitate single units.Daily total blood usage was significantly lower during downtime compared to prior 30 days (29 vs 37 units, p=0.004). Blood bank issued 20 emergency blood products including 15 RBCs, 4 platelets and 1 plasma. Blood bank provided blood products for 3 heart transplants. There were no massive transfusion protocol activations. Blood component modification including irradiation, washing and volume reduction of cellular products continued. Splitting components into aliquots resumed once ISBT 128 blood bank label software connectivity was restored; 17% of RBCs and 14% of platelets issued were aliquots.Five minor transfusion reactions were reported and all were unrelated to downtime. Blood inventory was stable and did not reach critical supply. Conclusions: Transfusion service downtime policies and procedures can optimize patient safety during extended downtime events. Mock drills and periodic review of blood bank downtime procedures including lab requisitions, blood orders, historical blood bank records, blood product labeling and modification can ensure safe transfusion service operations during extended downtime events.
