Determining Root Cause of Misuse and Wastage to Improve O Negative Utilization as Hospital System

Document Type

Conference Proceeding

Publication Date

10-1-2025

Publication Title

Transfusion

Abstract

Background/Case Studies: To ensure a well-preserved inventory at the blood center and hospitals, utilization metrics are established. The usage rate goal for O negative packed red blood cells (PRBC) set by the blood supplier is < 11%. Henry Ford Hospital (HFH) operates as the central hub for blood supply to its surrounding hospitals and maintains a monthly average usage rate of 9.7%. Henry Ford Jackson Hospital (HFJH) receives dedicated shipments from the blood supplier due to logistical limitations. In 2022, prior to intervention, HFJH maintained a monthly average usage rate of 13.3%. Study Design/Methods: To determine root cause (RC) of high usage rates at HFJH, 5 categories of O negative PRBC misuse and waste were established. The categories are General Wastage, Transfusion Not Appropriate, Emergent Release Misusage, Short Outdate Issued/Type Unavailable and Units Expired in Storage. These categories cover all potential causes of misuse or waste and breaks them down into easily identifiable RC's. It includes all forms of inappropriate handling, storage of units and transfusions. After each RC of misusage and wastage is identified, implementation of new standards and processes are completed. Actions taken started in 2023. To remedy Emergent Release Misusage, the trauma committee had discussions regarding expedited specimen procurement and patient registration for trauma patients, followed by the creation of a new Massive Transfusion (MTP) tracking log to include comments and problems during the MTP for immediate review. To combat the Short Outdate Issued/Type Unavailable category, inventory was increased for B negative and irradiated A negative PRBC's, and PRBC's with < 10 days until outdate were transferred to HFH. Results/Findings: From November 2022 through November 2023, the categories that showed significant misusage included Emergent Release Misusage and Short Outdate Issued/Type Unavailable. Reduction of occurrences in each RC category was successful and is shown below (Figure 1). HFJH achieved usage rates of 11.8% in 2023, 8.7% in 2024 and 6.8% through April in 2025. HFH maintained rates of 8.6% in 2023, 9.1% in 2024 and 8% through April in 2025. Review of issued and discarded units continued to ensure stability of reduced O negative usage rates. Conclusions: Determining RC's for misuse and waste of O negative PRBC's can lead to creation of standards and processes that improve O negative utilization. Working intra and inter departmentally was a key factor in reducing wastage. Use of accurate data to determine an appropriate amount of supply at each site considering their patient populations and location is integral to successful reduction. Reduction of misusage at the regional hospital by sending products to the central hub did not affect usage rates throughout the system due to adjustments to account for extra influx.

Volume

65

Issue

S2

First Page

291A

Last Page

292A

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