DUBAI HOSPITAL Pathology Department Haematology and Blood Bank Division REPORT ON PROJECT TO REDUCE TIME TAKEN BY BLOOD BANK STAFF TO CONVERT AND ORDER OF TYPE-ANDSCREEN TO CROSSMATCH AND DISPATCH THE BLOOD
Background: Crossmatching procedure involves blood grouping and compatibility testing of patient's serum with each individual unit to be prepared for patient. If 3 units of blood are requested then 3 crossmatching procedures will be carried out. Also, crossmatched units will be reserved for 3 days in a special fridge for the patient. They are not available to be used for any other patient. Type-and-screen procedure involves blood grouping and checking serum of the patient against a pool of screening red cells to make sure serum does not have irregular antibodies. Only one test is done. No unit is reserved for patient, except in the rare cases where antibodies are detected in serum. Comparison: Antibody screening is much less costly and, because blood is reserved there will be less blood expiry. It is best for use when patient is going for a procedure when the likelihood for need of blood is low (<20%) Hazards: However, if a patient for whom antibody screen was checked happens to bleed unexpectedly to the extent that he needs transfusion then Blood Bank is called to do quick crossmatching. Delay in this crossmatching, and in issuing of the blood will pose a danger to the patient. It will also lower confidence in the validity of requesting type-and-screen and make surgeon revert to the crossmatching procedure to cover their patients. It is acceptable to allow 20 minutes between ordering crossmatching and receiving the blood in such occasions when type-and-screen was ordered beforehand and blood transfusion need arises unexpectedly. The aim of this project carried out in the Blood Bank of DH was to make sure we reach the status when ALL such requests are provided within the twenty minutes period. If we reach such a status we would not only help the doctors and patients but we would raise confidence in the type-and-screen procedure and make doctors accept following it. Thus cost of blood bank work will drop and loss of blood units by expiry will drop. Plan: Education: Blood Bank staff was to be continually educated about this project to make sure they comply with the expected standards. 1
Baseline statistics: Three months of April to June 2008 were taken as baseline and efforts to improve. Statistics for the 6 months of July to December 2008 to see the effectiveness of the project. RESULTS Basic Statistics April-June 2008 Month April Number of patients 10 Range (min) 15-25 % >20 min 30 Mean (min) 20
May 13 15-30 30.7 21.08
Statistics for July-December* 2008 Month July August Sept Number 14 15 11 of patients Range 15-25 13-35 14-23 (min) %>20 7 20 9 min Mean 18.9 19.7 17.4 (min) * December from 1st to 20th.
June 3 18-23 33 20.3 Oct 12
Nov 6
16-22
16-20
8
0
19
18.5
Dec*
2