Johns Hopkins Hospital Baltimore, Maryland, United States
Background/Case Studies: The transfusion service excels at managing a hospital-based tissue service (HTS) due to expertise in inventory stewardship, bidirectional traceability, and quality assurance. We hypothesized that active inventory management and regular feedback on tissue discard using the hospital event reporting system (ERS) would reduce waste. We also assessed whether creation of a tissue lead technologist role would further enhance compliance and reduce waste by providing dedicated oversight and timely follow-up.
Study
Design/Methods: A single center retrospective study was conducted to evaluate tissue activity data detailing issuance, implantation, return, discard, and/or expiration of tissues. These data were compiled from commercially available tissue tracking software over a 14-month period (3/1/23-4/30/2024). Tissue activity data were shared at monthly tissue quality assurance meetings with stakeholders from surgical services and the hospital value analytics. The total waste cost was calculated as the sum of the cost of discarded tissue (i.e., unacceptable to return to inventory following issue), the cost of tissue expiration while in HTS inventory, and the cost of HTS errors (i.e., tissue improperly stored while rearranging inventory). Beginning February 2024, tissue discard reports were entered into the ERS by the quality assurance specialist at the direction of the tissue lead technologist. These reports included education for surgical teams about criteria for reacceptance of frozen tissue products into HTS inventory. Strategies to reduce tissue expiration included 1) close communication with hospital value analysis committee 2) careful vetting of new tissue products, which includes a comparison relative to existing tissue products in the HTS inventory.
Results/Findings: The HTS issued 12,775 tissue products during the study period (mean ± standard deviation (SD) 913±146 tissue products/month). Of these, 66.7% (8,522) were implanted, 33.3% (4,253) were returned to the HTS and 1.2% (147) were discarded. The mean±SD cost of waste was $27,566.76±$16,378.79 (USD)/month. Tissue discard following issue accounted for 52.0% of the waste cost, tissue expiration in inventory accounted for 44.6% of the waste cost, and HTS error accounted for the remainder. The top reasons for tissue discard following issue were frozen tissue thawed but unused and sterile packaging opened but tissue unused. Mean monthly tissue waste cost was variable and did not significantly differ between the first and second halves of the study ($22.859.65±$21,319.05 vs. $32,536.87±$8,312.67, p=0.28). Conclusions: Thorough analysis of tissue activity data, coupled with dedicated oversight, demonstrates the potential for refining tissue management processes to reduce waste and costs in the hospital setting. Finally, it is essential to ensure accurate tissue pricing when calculating the cost of waste as the cost of individual products may change.
