title: How we treat: transfusion medicine support of obstetric services.
abstract: BACKGROUND
  Obstetric services depend on the transfusion service (TS) to provide diagnostic testing and blood component therapy for clinical care pathways.
  
  
  METHODS
  We describe three quality improvement (QI) initiatives implemented to improve TS support of obstetric services.
  
  
  RESULTS
  We implemented a pathway for patients requiring an ABO/Rh order for every admission to obstetric services, along with reconciliation of the daily hospital birth manifest and TS umbilical cord log to identify every woman eligible for RhIG. After assessment over 6 months, 21 (1%) of 2041 women lacked an admission ABO/Rh; all subsequently had ABO/Rh determinations. Umbilical cords were missing for eight (0.4%) mothers; four were D- and received RhIG. We developed algorithms for diagnostic blood ordering for patients deemed at "low,""moderate," or "high" risk of blood transfusion. A 27% reduction in total diagnostic test volumes and 24% reduction in charges was documented after compared to before implementation. We analyzed the impact of our massive transfusion protocol (MTP) on blood inventory management for 31 (0.25%) women undergoing 12,945 deliveries, representing 11% of 286 MTPs for all clinical services over a 32-month interval. O- uncrossmatched red blood cells (RBCs) represented 103 (24%) of 421 RBC units issued. Wastage rates of RBCs, plasma, and platelets ordered and issued in the MTPs were 0.7, 16, and 3%, respectively.
  
  
  CONCLUSIONS
  QI initiatives for RhIG prophylaxis, diagnostic blood test ordering, and MTP improve TS support of obstetric services.
authors.affiliation: Department of Pathology and Medicine and Obstetrics and Anesthesiology, Stanford University School of Medicine, Stanford, California 94305, USA. ltgoodnough@stanfordmed.org
authors.forename: Lawrence T
authors.initials: LT
authors.lastname: Goodnough
authors.forename: Kay
authors.initials: K
authors.lastname: Daniels
authors.forename: Amy E
authors.initials: AE
authors.lastname: Wong
authors.forename: Maurene
authors.initials: M
authors.lastname: Viele
authors.forename: Magali F
authors.initials: MF
authors.lastname: Fontaine
authors.forename: Alexander J
authors.initials: AJ
authors.lastname: Butwick
mesh_terms: D000017:ABO Blood-Group System; D000465:Algorithms; D016913:Blood Component Transfusion / Q000379:methods* / Q000592:standards; D001788:Blood Grouping and Crossmatching / Q000379:methods*; D036861:Delivery, Obstetric; D005260:Female; D006801:Humans; D009774:Obstetrics / Q000379:methods*; D011785:Quality Assurance, Health Care; D012203:Rh Isoimmunization / Q000175:diagnosis* / Q000188:drug therapy; D012204:Rh-Hr Blood-Group System; D018029:Rho(D) Immune Globulin / Q000627:therapeutic use
chemical_list: D000017:ABO Blood-Group System; D012204:Rh-Hr Blood-Group System; D018029:Rho(D) Immune Globulin