title: Incomplete pretransfusion testing leads to surgical delays.
abstract: BACKGROUND
  The Joint Commission has highlighted the importance of having appropriate and complete pretransfusion testing before surgery begins. The maximum surgical blood ordering schedule (MSBOS) indicates which patients require preoperative transfusion testing. We determined the number of times surgical delays were caused due to the lack of completed pretransfusion testing.
  
  
  METHODS
  All transfusion events reported through the common medical event reporting system of eight networked hospitals over a 12-month period were evaluated to determine how often patients experienced surgical delays due to not having complete pretransfusion testing.
  
  
  RESULTS
  During this 12-month period 12 patients were identified who were either in or en route to the operating room with incomplete pretransfusion testing leading to a delay in providing crossmatched red blood cells (RBCs). In 6 of 12 cases a new antibody was discovered, which required extra time for the provision of crossmatched RBCs, while in 4 of 12 patients the samples were not sent or were lost on the way to the blood bank. In the remaining two patients other parts of the pretransfusion testing process were not followed according to hospital policy. The median surgery start time delay was approximately 12 hours (range, 1-168 hr) in 11 of 12 cases. One patient's case was not aborted when it was discovered that crossmatched RBCs were not immediately available due to newly detected alloantibodies.
  
  
  CONCLUSIONS
  We identified three mechanisms by which delays in completing pretransfusion testing in surgical patients occurred. Adherence to the MSBOS and sample collection policies should reduce delays.
authors.affiliation: Department of Pathology, The Institute for Transfusion Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania 15213, USA.
authors.forename: Brian
authors.initials: B
authors.lastname: McWilliams
authors.forename: Mark H
authors.initials: MH
authors.lastname: Yazer
authors.forename: James
authors.initials: J
authors.lastname: Cramer
authors.forename: Darrell J
authors.initials: DJ
authors.lastname: Triulzi
authors.forename: Jonathan H
authors.initials: JH
authors.lastname: Waters
mesh_terms: D001071:Appointments and Schedules; D001771:Blood Banks / Q000458:organization & administration*; D001788:Blood Grouping and Crossmatching / Q000706:statistics & numerical data*; D001800:Blood Specimen Collection / Q000379:methods; D001803:Blood Transfusion / Q000706:statistics & numerical data; D002585:Cesarean Section; D017558:Elective Surgical Procedures; D057286:Electronic Health Records; D004630:Emergencies; D005260:Female; D006747:Hospital Communication Systems; D006764:Hospitals, Community / Q000458:organization & administration / Q000706:statistics & numerical data; D006776:Hospitals, Pediatric / Q000458:organization & administration / Q000706:statistics & numerical data; D006801:Humans; D007518:Isoantibodies / Q000097:blood*; D008297:Male; D057725:Operative Blood Salvage; D011247:Pregnancy; D011300:Preoperative Care / Q000379:methods / Q000706:statistics & numerical data; D062606:Tertiary Care Centers / Q000458:organization & administration / Q000706:statistics & numerical data; D013997:Time Factors; D014932:Women's Health Services / Q000458:organization & administration / Q000706:statistics & numerical data
chemical_list: D007518:Isoantibodies