(P-TS-48) Evaluation of Second Tube Utilization When Performing a Type and Screen Test in Blood Bank

Background/Case Studies: In November 2023, a specimen quality audit was performed at Wisconsin Diagnostic Laboratories(WDL), Froedtert Hospital (FH). The scope of the audit was to evaluate the draw quality of the Type and Screen (TS) samples received in the blood bank over the course of two weeks. It would evaluate the amount of sample received versus the amount of sample that was expected. Current policy for TS orders indicates a patient should have two 4mL lavender (LAV) top tubes drawn to complete testing. In the specimen quality audit approximately one third of the samples tested had less than 4mL total, while only half of that third were single tube draws. Two locations within the hospital had 41% and 14% of samples tested that were single tubes versus the two LAV specimens that were expected. This particular deviation to policy had little to no major impact on the workflow for these specific tests ordered. Therefore, blood bank’s leadership wanted to explore the possibility of discontinuing the draw of two LAV tubes for TS tests ordered. The purpose of the TS second tube utilization audit was to determine the necessity of drawing two EDTA LAV tubes for all TS orders and to assess the amount of times the second tube was required for testing. The ultimate aim was to discontinue the draw of two LAV tubes for TS orders in the following fiscal year if evidence supported the new proposal.

Study

Design/Methods: An audit performed at FH during a two week period in December 2023, where all TS samples tested were evaluated to assess the use of the second tube. During this period the TS samples tested were counted. This audit also assessed the reasoning for having to utilize the second tube, whether it was due to a short draw or complex antibody workup.

Results/Findings: During the fourteen day period the audit took place, 1472 TS samples were tested in the blood bank. Of those samples only 7 required the use of the second tube to complete all testing. 5 of those 7 samples were patients with antibodies that required several panels to be tested, complete crossmatches, or antibody titrations. One of those 7 samples was a patient who had an invalid ABORH due to a Massive Transfusion Protocol, therefore the patient required immediate spin crossmatches. One of those 7 samples was a short draw and required the use of both LAVs to complete the TS using tube methodology. It was also noted that 5 of these samples were very short draws or were drawn in 2mL LAV top tubes.

Conclusions: These findings have helped determine that only one 4mL LAV tube is needed for TS testing. With the evidence that was collected over the course of 14 days the policy at WDL, FH will change to have only one LAV tube drawn for TS orders. This new workflow will help reduce costs (Est. $2,500/year), storage space and decrease the amount of blood patients need drawn.