title: Blood ordering from the operating room: turnaround time as a quality indicator.
abstract: BACKGROUND
  Quality indicators in transfusion medicine are necessary for patient safety and customer satisfaction. The turnaround time (TAT) of issuing red blood cells (RBCs) has emerged as a quality indicator but is not an established benchmark. We examined the TAT for issuing RBCs from the blood bank to the operating rooms (ORs) at Vanderbilt University Medical Center (VUMC) and Stanford University Medical Center (SUMC).
  
  
  METHODS
  TAT was defined from time of request to when RBCs exited the blood bank. Cases eligible for analysis had completed type-and-screen results with requests for four or fewer RBC units. Patients with a positive antibody screen had serologically crossmatched units prepared and reserved for intraoperative use. We also e-mailed surveys to academic institutions to establish the current state of TAT monitoring and to anesthesiologists at VUMC to gauge the TAT expectations of the OR.
  
  
  RESULTS
  The mean TATs at the two institutions were comparable (VUMC, 10 ± 3.8 min; SUMC, 14 ± 7.2 min) for orders of RBCs. The most common reasons for delayed TAT were overlapping orders, medical technologists occupied by phone calls, and oversaturation of pneumatic tube stations. Only 3 of 24 surveyed institutions actively monitored RBC TAT. Surveyed anesthesiologists (n = 7) reported an expectation for RBC TAT of 5 to 15 minutes for urgent cases. Established internal TAT policies were 15 and 20 minutes at VUMC and SUMC, respectively, for crossmatched RBC requests for patients with complete diagnostic testing.
  
  
  CONCLUSIONS
  Many of the surveyed institutions do not monitor stat RBC issue TAT as a quality indicator. This study serves as a starting point for establishing a benchmark for TAT for issuing RBCs from the blood bank to ORs.
authors.affiliation: Department of Veterans Affairs Medical Center, Nashville, Tennessee, USA.
authors.forename: Colt M
authors.initials: CM
authors.lastname: McClain
authors.forename: Jonathan
authors.initials: J
authors.lastname: Hughes
authors.forename: Jennifer C
authors.initials: JC
authors.lastname: Andrews
authors.forename: Jennifer
authors.initials: J
authors.lastname: Blackburn
authors.forename: Stephanie
authors.initials: S
authors.lastname: Sephel
authors.forename: Dan
authors.initials: D
authors.lastname: France
authors.forename: Maurene
authors.initials: M
authors.lastname: Viele
authors.forename: Lawrence T
authors.initials: LT
authors.lastname: Goodnough
authors.forename: Pampee P
authors.initials: PP
authors.lastname: Young
mesh_terms: D017707:Erythrocyte Transfusion; D006801:Humans; D009873:Operating Rooms; D019984:Quality Indicators, Health Care; D013997:Time Factors