Quality improvement methodologies increase autologous blood product administration

Area of Science:

• Anesthesiology
• Cardiovascular Surgery
• Quality Improvement

Background:

• Whole blood from cardiopulmonary bypass may be reinfused using a cell saver (CS).
• Significant CS blood volume was being discarded at the institution.
• A multidisciplinary team identified challenges in complete autologous blood delivery.

Purpose of the Study:

• To investigate and reduce the waste of cell saver blood volume during cardiac surgery.
• To implement interventions aimed at maximizing autologous blood reinfusion.

Main Methods:

• A multidisciplinary team reviewed 21 cardiac surgery patient charts to analyze CS waste.
• Quality improvement tools including fishbone diagrams and Plan-Do-Study-Act (PDSA) cycles were utilized.
• Interventions involved data collection, didactic education, and management of change.

Main Results:

• Before interventions, 80% of patients under 6 kg and 25% of patients over 36 kg experienced CS blood waste.
• 75% of pediatric patients (<6 kg) with wasted CS blood received packed red blood cell transfusions post-operatively.
• Following interventions, CS blood waste decreased to 5% after Cycle I and 100% utilization was achieved after Cycle II.

Conclusions:

• Root cause analysis and targeted interventions effectively reduced cell saver blood waste.
• Implementing education, training, and change management strategies ensured complete utilization of autologous blood.
• This quality improvement initiative enhanced patient care by optimizing blood product management during cardiac surgery.