title: Quality management in the transfusion service: case studies in process improvement.
abstract: BACKGROUND
  Laboratory-based quality improvement (QI) initiatives can improve clinical outcomes and patient safety.
  
  
  METHODS
  We present three cases of QI that impact processes from the transfusion service (TS) laboratory to the patient's bedside.
  
  
  RESULTS
  Case 1 was event discovery reporting (EDR). We were able to reduce our biologic product deviation reports from 41 (17%) of 238 EDRs to only 19 (7%) of 272 (p < 0.01) EDRs after implementation of a QI workflow process. Case 2 was antibody evaluation before elective surgery. We implemented process improvement strategies: 1) surgical safety checklist with confirmation of type-and-screen completion and antibody evaluation before patients can proceed to surgery; 2) specimen retention policy of 30 days to allow advance testing; and 3) daily review to identify specimens needed on day of surgery. After intervention, only 7 (0.3%) of 2298 patients required antibody evaluation on day of surgery, compared to 65 (0.75%) of 8656 patients (p < 0.01) before intervention. Case 3 was wrong blood in tube (WBIT). We have a two-specimen requirement for blood type verification before transfusion. To determine whether trauma patients should be exempted, we reviewed WBIT errors. Six WBIT errors were from the emergency department (an error rate of 1:400) and nine WBIT specimens were institution-wide. Three patients were transfused after correction of the WBIT error. Based on this analysis, our institution agreed that no clinical units shall be exempted from our policy.
  
  
  CONCLUSIONS
  Successful QI in the TS improves processes that promote efficiency, effectiveness, and patient safety.
authors.affiliation: Department of Pathology, Stanford University School of Medicine, Stanford University Medical Center, Stanford, California 94305, USA. ltgoodnough@stanfordmed.org
authors.forename: Lawrence T
authors.initials: LT
authors.lastname: Goodnough
authors.forename: Maurene
authors.initials: M
authors.lastname: Viele
authors.forename: Magali
authors.initials: M
authors.lastname: Fontaine
authors.forename: Lee
authors.initials: L
authors.lastname: Chua
authors.forename: Zenaida
authors.initials: Z
authors.lastname: Ferrer
authors.forename: Christine
authors.initials: C
authors.lastname: Jurado
authors.forename: Peter
authors.initials: P
authors.lastname: Quach
authors.forename: Marsha
authors.initials: M
authors.lastname: Dunlap
authors.forename: Daniel A
authors.initials: DA
authors.lastname: Arber
mesh_terms: D000017:ABO Blood-Group System / Q000276:immunology; D000906:Antibodies / Q000097:blood; D001787:Blood Group Incompatibility; D001803:Blood Transfusion / Q000592:standards*; D006801:Humans; D011785:Quality Assurance, Health Care; D058996:Quality Improvement
chemical_list: D000017:ABO Blood-Group System; D000906:Antibodies