Thomas Jefferson University Hospital, Pennsylvania, United States
Background/Case Studies: “Type & screen” (T&S) is often part of routine laboratory testing, even when transfusion is not anticipated. This may occur to limit patient phlebotomy and to expedite transfusion, if needed. That said, performing a T&S when transfusion is not anticipated creates unnecessary blood bank laboratory testing and costs. The authors’ blood bank laboratory has historically allowed certain hospital areas to collect a “Draw & Hold” (D&H) specimen in lieu of a T&S. The D&H specimen allows the clinical team to draw a blood bank specimen, as convenient, and the specimen is stored, untested, in the lab for up to three days. The D&H is converted to a T&S only if the patient requires a transfusion during the three day period. On 3/21/23, the D&H option was made available to all hospital areas.
Study
Design/Methods: To begin to assess the now wider use of D&H, data collection focused on a specific inpatient floor that had not previously used D&Hs. This specific floor serves cardiology and cardiac surgery patients. The number of D&H specimens ordered by this specific floor were quantified after the D&H was made available to all hospital areas (3/21/23-3/7/24). D&H specimens that were converted to a T&S were explored. Patient hemoglobin results within 24 hours of the D&H order were also analyzed. D&H specimens were not included if the specimen order was canceled, if the blood bank converted the D&H to a T&S without an order for blood products, if a D&H specimen was drawn on a patient with an active T&S, and if a D&H specimen was collected simultaneously with a T&S.
Results/Findings: After D&H was made available to all hospital areas, this specific floor ordered 107 D&H specimens. Only eight (7%) were converted to a T&S. Four of the eight were converted to T&S for a surgical procedure. The other four were converted to a T&S for routine red cell transfusion with pretransfusion hemoglobins of 6.2, 6.6, 7.1, and 7.1 g/dL, respectively. For these four transfusions, the time from blood order to blood being available was no more than 2 hours 10 minutes. Excluding those patients whose D&H was converted due to a surgical procedure, no patient with a hemoglobin greater than 7.2 g/dL had a D&H converted to a T&S. Conclusions: If D&H orders had not been available to all hospital areas, presumably, each of these D&H specimens would have been ordered as a T&S. Thus, D&H specimens minimize unnecessary blood bank laboratory testing and costs. As so few D&H specimens were converted to T&S specimens, one could argue that, to prevent iatrogenic anemia, these specimens should not have been drawn at all. Rather, T&S should be drawn only when transfusion or surgery is planned. The authors will continue to study the impact of implementing D&H in a variety of hospital areas. Implementation of the “Draw and Hold” minimizes unnecessary blood bank testing and related costs without compromising timely patient care
