Continuous quality management: A prospective audit of practice for uncrossed match blood ordering in a level i trauma unit

Introduction: Acutely injured victims brought to our Level I Trauma Center have uncrossed match (type O negative) Wood ordered prior to meir arrival, but only 7S receive transfusions. We evaluated the need to order blood prior to any patient arrival and analyzed which of the Florida Human Resource Service's (MRS) 13 trauma referral criteria best predict emergent transfusion. Methods: A prospective three month audit of 472 consecutive évaluable Level 1 Trauma Center adult admissions, of which SO patients (pis.) received 185 units, was reviewed and a two month prospective evaluation conducted. Results were analyzed by one way ANOVA and Students' T test Results: Field and arrival systolic Wood pressure (SBP) and major penetrating injury to torso predicted blood requirements, incorporatini all patients with Glasgow Coma Sole( CCS) < I3(p<.0l). HRS Trauma Pt. #pts. receiving # of Avg. time to Criteria blood units transfusion (min) SBP<90mmHg 66 17 70 16 GCS<13 85 12 44 23 Penetrating torso 114 11 27 16 High suspicion 114 4 19 50 All other criteria 94 6 20 43 Average time of blood delivery from the blood bank was six minutes (mode *5 minutes). There was a major reduction in the mean units of Mood requested (792/month to 440/monm) and increased utilization (7% to 20%) following the implementation of a prearrival blood ordering practice utilizing only these two criteria. No adverse events occurred with this new policy. CoockBie: Criteria for appropriate utilization of banked blood aie necessary to minimize waste of this critical resource. By implementing a quality performance audit, we were able to reduce the number of pre-arrival requests for uncrossed matched blood by nearly 50%, improving blood and blood bank personnel utilization, while preserving patient safety.