title: Reducing intraoperative red blood cell unit wastage in a large academic medical center.
abstract: BACKGROUND
  The wastage of red blood cell (RBC) units within the operative setting results in significant direct costs to health care organizations. Previous education-based efforts to reduce wastage were unsuccessful at our institution. We hypothesized that a quality and process improvement approach would result in sustained reductions in intraoperative RBC wastage in a large academic medical center.
  
  
  METHODS
  Utilizing a failure mode and effects analysis supplemented with time and temperature data, key drivers of perioperative RBC wastage were identified and targeted for process improvement.
  
  
  RESULTS
  Multiple contributing factors, including improper storage and transport and lack of accurate, locally relevant RBC wastage event data were identified as significant contributors to ongoing intraoperative RBC unit wastage. Testing and implementation of improvements to the process of transport and storage of RBC units occurred in liver transplant and adult cardiac surgical areas due to their history of disproportionately high RBC wastage rates. Process interventions targeting local drivers of RBC wastage resulted in a significant reduction in RBC wastage (p < 0.0001; adjusted odds ratio, 0.24; 95% confidence interval, 0.15-0.39), despite an increase in operative case volume over the period of the study. Studied process interventions were then introduced incrementally in the remainder of the perioperative areas.
  
  
  CONCLUSIONS
  These results show that a multidisciplinary team focused on the process of blood product ordering, transport, and storage was able to significantly reduce operative RBC wastage and its associated costs using quality and process improvement methods.
authors.affiliation: Department of Anesthesiology, Vanderbilt University, Nashville, Tennessee.
authors.forename: Gina M
authors.initials: GM
authors.lastname: Whitney
authors.affiliation: Program for Quality, Safety, and Risk Prevention, Nashville, Tennessee.
authors.forename: Marcella C
authors.initials: MC
authors.lastname: Woods
authors.affiliation: Department of Anesthesiology, Vanderbilt University, Nashville, Tennessee.
authors.forename: Daniel J
authors.initials: DJ
authors.lastname: France
authors.affiliation: Department of Anesthesiology, Vanderbilt University, Nashville, Tennessee.
authors.forename: Thomas M
authors.initials: TM
authors.lastname: Austin
authors.affiliation: Department of Anesthesiology, Vanderbilt University, Nashville, Tennessee.
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Deegan
authors.affiliation: Department of Pathology, Microbiology, and Immunology, Nashville, Tennessee.
authors.forename: Allison
authors.initials: A
authors.lastname: Paroskie
authors.affiliation: Department of Pathology, Microbiology, and Immunology, Nashville, Tennessee.
authors.forename: Garrett S
authors.initials: GS
authors.lastname: Booth
authors.affiliation: Department of Pathology, Microbiology, and Immunology, Nashville, Tennessee.
authors.forename: Pampee P
authors.initials: PP
authors.lastname: Young
authors.affiliation: Department of Urologic Surgery, Vanderbilt University, Nashville, Tennessee.
authors.forename: Roger R
authors.initials: RR
authors.lastname: Dmochowski
authors.affiliation: Department of Anesthesiology, Vanderbilt University, Nashville, Tennessee.
authors.forename: Warren S
authors.initials: WS
authors.lastname: Sandberg
authors.affiliation: Department of Anesthesiology, Vanderbilt University, Nashville, Tennessee.
authors.forename: Michael A
authors.initials: MA
authors.lastname: Pilla
mesh_terms: D000046:Academic Medical Centers / Q000706:statistics & numerical data; D001793:Blood Preservation / Q000009:adverse effects; D017707:Erythrocyte Transfusion / Q000706:statistics & numerical data; D004912:Erythrocytes; D006801:Humans; D059035:Perioperative Period; D012984:Software