Road to zero blood waste: Improving intraoperative blood utilization through a multidisciplinary collaborative
Navas-Blanco J, Lopez-Plaza I, Nakai K, Isley M, Ghatol D, Brightman D, Parrott S, Galusca D. Road to zero blood waste: Improving intraoperative blood utilization through a multidisciplinary collaborative. Anesthesia & Analgesia 2017; 125(3):24-25.
Anesthesia & Analgesia
Introduction: Allogeneic blood transfusions represent an area of resource overutilization and waste for many healthcare organizations. A multidisciplinary team consisting of Departments of Anesthesiology, Blood Bank, Surgery and perioperative nursing staff was created. Collaborative efforts were translated in the implementation of several changes in institutional protocols, educational activities, policies and electronic medical record modifications lead to a significant reduction of total blood waste in the operating room. The team used Lean Six Sigma methodology with its five phases- define, measure, analyze, improve and control- to reduce intraoperative blood wastage. We present the different stages of this multi-year project compiling various changes implemented, the timeline of work plan, the financial impact due to reduction in monthly blood product waste and the next steps in our road to zero intraoperative blood waste and sustainability. Methods: As part of implementation of the Lean Six Sigma Methodology for our project, we conducted an analysis of the previous practice for allogeneic blood conservation and management to identify pitfalls, tracking of type of products wasted and its financial impact and analysis of previous performance. These parameters represented our baseline data through which metrics and policy changes were implemented originally in 2011 and allowed the creation of a yearly work-plan including: improvement in blood conservation equipment, education and training of all personnel handling blood products, inter-departmental communication improvement, enhanced tracking system for blood products used and wasted and sustainability. Results: Astonishing results were evidenced since the implementation of our project, evidenced by a decreased of total blood units wasted with its subsequent decrease in its financial impact. Additionally, we were able to demonstrate high value care by preserving the same quality of service (average number of surgical cases per year) and decreasing the cost associated to blood waste (figure 1). Discussion: Handling and management of allogeneic blood products in large academic institutions can be challenging. Minimizing the wastage of blood products as a valuable and limited resource is of paramount importance for financial and ethical reasons. We demonstrate ways to minimize intraoperative blood waste and quantify its financial impact while promoting same high-value within our institution.