(P-TS-6) Accelerating Treatment Delivery and Reducing Waste with Implementation of Pathogen Reduced Cryoprecipitated Fibrinogen Complex

Background/Case Studies: UCSF Health operates three blood banks, one at each of its medical centers: Parnassus Heights, Mission Bay, and Mount Zion. Collectively, these banks transfuse over 60,000 blood products annually, including 2,300 cryoprecipitated (cryo) AHF pools. The breakdown of cryo orders is 91% at Parnassus Heights, 9% at Mission Bay, and less than 1% at Mount Zion. UCSF Health routinely implements processes and products that improve blood stewardship, efficiency, access, reduce waste, and enhance patient safety. UCSF Health can store red blood cells, plasma, and platelets ready for immediate use, but cryo AHF must be stored frozen due to its short 4-6 hour post-thaw shelf life, partly due to the risk of transfusion-transmitted infections.
To address long turnaround times and high cryo AHF waste, UCSF Health implemented Pathogen Reduced Cryoprecipitated Fibrinogen Complex (IFC), a cryoprecipitate product made from pathogen-reduced plasma that can be stored thawed at room temperature for up to five days for treating and controlling bleeding associated with fibrinogen deficiency. UCSF Health onboarded IFC in October 2022. By July 2023, 99% of cryo orders were filled using IFC. Based on historical transfusion data, UCSF Health initiated maintaining two units of prethawed IFC at its Parnassus Heights campus at all times starting in October 2023, which was increased to four units in March 2024. The turnaround time (TAT) data presented here represents all orders across the entire UCSF Health system.

Study

Design/Methods: From October 2022 through March 2024, 2,844 IFC units (FC15) were transfused. Turnaround time (TAT) from order receipt to product allocation (ready and assigned to the patient) and wastage were obtained from Crystal Reports. A retrospective analysis of TAT for cryo AHF versus IFC was performed for orders prior to IFC implementation (January-October 2022) and post implementation of IFC (July 2023-March 2024). Outliers, including all orders taking more than 60 minutes to issue, were considered non-urgent orders.
 

Results/Findings: Between January and October 2022, 909 cryo AHF orders were processed. During this period, 6% of orders had a 0-19 minute TAT, and 49% had a 20-39 minute TAT. Post-IFC implementation, between July 2023 and March 2024, 1,638 IFC orders were processed. Of these, 53% of IFC orders had a 0-19 minute TAT, with 41% in 0-4 minutes, and 22% had a 20-39 minute TAT (Table 1). Prior to IFC implementation, cryo AHF had the highest rate of blood component wastage at 15% system-wide. Post-IFC implementation, wastage was nearly eliminated (< 1%).

Conclusions: The implementation of IFC has significantly reduced TAT and accelerated the delivery of a critical source of fibrinogen for hemorrhaging patients. Additionally, IFC has dramatically reduced wastage and improved productivity, efficiency, and blood stewardship.