(P-QU-11) Platelet Refractory Work-Up: Epic Beaker Follow-Up Worklist Improves Workflow Efficiency

Sunday, October 20, 2024

12:00 PM - 1:00 PM

Presenting Author(s)

CY

Chloe M. Young, n/a (she/her/hers)

Oregon Health Sciences University, Portland, OR
Beaverton, Oregon, United States

Background/Case Studies: Confirming Human Leukocyte Antigen (HLA) alloimmunization requires costly and time-consuming testing, prompt interdisciplinary communication, and careful coordination of special blood product acquisition. The multifaceted process of HLA antibody testing and reporting may be negatively affected by inefficient workflows. Historically, the workflow at a single public academic health center risked discontinuous interfacing of, and delayed communication between, the clinical and laboratory stakeholders, p</span>otentially having negative impacts on the timeliness of providing compatible blood products.

Study

Design/Methods: A quality improvement project was designed to improve the HLA alloimmunization testing workflow via development of an automated follow-up worklist function within the laboratory information system (LIS) (Epic Beaker; EPIC Systems Corporation). Multiple plan-do-study-act cycles were performed, resulting in changes to test ordering, inter-laboratory communication, and documentation of results by transfusion medicine providers and blood bank technologists. Measured outcomes included improved workflow step turnaround times (TAT) and completion of documentation in a clinical note. Results were assessed for statistical significance using ANOVA and chi-square tests.

Results/Findings: The worklist was developed using records for 260 platelet refractory workups from April 3rd 2021 to April 3rd 2024 for 210 patients. Average age was 56 years, 88 (42%) of whom were female. Results showed that 48 (18%) workups were positive for HLA antibodies, with refractory patients showing an average cPRA of 72% (0-100%). The average TAT from test ordering to documentation of these results in the blood bank LIS was 5.9 days. Further stratification reveals a statistically significant decrease in this TAT by year, from 6.1 days in 2021 to 4.2 days in 2024 (p = 0.032), likely attributable to increased use of the worklist by blood bank staff. The average TAT from test ordering to a completed clinical note was 4.0 days and there was no change in this TAT following implementation of the worklist (p = 0.459). Clinical notes were missing for 160 (62%) of workups and there was no change in the rates of completed notes over time (p = 0.0629), highlighting an area for improvement.

Conclusions: Development of a follow-up worklist for HLA platelet refractory testing improved workflow efficiency while highlighting areas for improvement. Benefits of the worklist include automatically capturing test orders, improving turnaround time for documentation, and simplifying distribution of responsibilities within the workflow. The authors believe this workflow could be further developed to minimize unnecessary testing for platelet refractoriness. Furthermore, the success of this workflow could be applied to other Transfusion Medicine testing scenarios.