Are changes in admission practices for elective surgery posing a transfusion threat to patients?
There is an increasing emphasis on reducing in-patient hospital stay for elective surgical procedures. As a result, pre-operative stay has shortened, with less time available for performing baseline investigations before surgery, including those required to ensure a supply of safe, compatible blood. We have estimated the frequency of failure to complete 'group and screen' (G&S) testing before surgery where indicated, so that neither group-compatible blood nor crossmatched blood could be provided promptly if an unexpected haemorrhage occurs. Retrospective data were obtained from elective surgical procedures performed over a 3-week period. Of the 309 procedures performed, 21 patients were exposed to the risk of failure to provide appropriately matched blood had an emergency arisen. (In 20, a G&S was required; in one, a crossmatch was required.) Late samples and lack of information on the request form regarding the date and time of surgery were the main causes. Procedures requiring G&S only as opposed to crossmatch posed the greatest risk. Urgent measures are needed to ensure that, where indicated, a pre-operative G&S result is available before surgery begins. Educating colleagues, redesigning request forms and improving out-of-hour laboratory services and hospital information systems are the main steps needed to reduce this latent risk.
Chiganti
S
S
Hammersmith Hospitals NHS Trust, National Blood Service, North London, UK.
Regan
F
F
D001788:Blood Grouping and Crossmatching / Q000592:standards*; D001803:Blood Transfusion / Q000592:standards*; D017558:Elective Surgical Procedures / Q000145:classification / Q000592:standards* / Q000639:trends; D006760:Hospitalization / Q000639:trends*; D006801:Humans; D019300:Medical Errors / Q000517:prevention & control; D011300:Preoperative Care / Q000592:standards / Q000639:trends; D012189:Retrospective Studies; D012306:Risk