title: Exponential error reduction in pretransfusion testing with automation.
abstract: BACKGROUND
  Protecting the safety of blood transfusion is the top priority of transfusion service laboratories. Pretransfusion testing is a critical element of the entire transfusion process to enhance vein-to-vein safety. Human error associated with manual pretransfusion testing is a cause of transfusion-related mortality and morbidity and most human errors can be eliminated by automated systems. However, the uptake of automation in transfusion services has been slow and many transfusion service laboratories around the world still use manual blood group and antibody screen (G&S) methods.
  
  
  METHODS
  The goal of this study was to compare error potentials of commonly used manual (e.g., tiles and tubes) versus automated (e.g., ID-GelStation and AutoVue Innova) G&S methods. Routine G&S processes in seven transfusion service laboratories (four with manual and three with automated G&S methods) were analyzed using failure modes and effects analysis to evaluate the corresponding error potentials of each method.
  
  
  RESULTS
  Manual methods contained a higher number of process steps ranging from 22 to 39, while automated G&S methods only contained six to eight steps. Corresponding to the number of the process steps that required human interactions, the risk priority number (RPN) of the manual methods ranged from 5304 to 10,976. In contrast, the RPN of the automated methods was between 129 and 436 and also demonstrated a 90% to 98% reduction of the defect opportunities in routine G&S testing.
  
  
  CONCLUSIONS
  This study provided quantitative evidence on how automation could transform pretransfusion testing processes by dramatically reducing error potentials and thus would improve the safety of blood transfusion.
authors.affiliation: Ortho-Clinical Diagnostics, Raritan, New Jersey 08869, USA.
authors.forename: Susan F
authors.initials: SF
authors.lastname: South
authors.forename: Tony S
authors.initials: TS
authors.lastname: Casina
authors.forename: Lily
authors.initials: L
authors.lastname: Li
mesh_terms: D000372:Agglutination Tests / Q000592:standards; D000906:Antibodies / Q000032:analysis / Q000097:blood; D057205:Automation, Laboratory / Q000295:instrumentation / Q000379:methods / Q000592:standards; D001771:Blood Banks / Q000592:standards*; D001788:Blood Grouping and Crossmatching / Q000295:instrumentation* / Q000592:standards*; D001803:Blood Transfusion / Q000592:standards*; D006801:Humans; D019300:Medical Errors / Q000517:prevention & control; D012308:Risk Management / Q000379:methods / Q000592:standards; D013048:Specimen Handling / Q000592:standards; D000094902:Blood Banking / Q000379:methods*
chemical_list: D000906:Antibodies