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Massive blood loss protocol 'Code Red' at Papworth Hospital: A closed loop audit
M Tennyson1, J Redlaff2, G Biosse-Duplan2
1Addenbrooke's Hospital, Cambridge, UK.
Insights
The "Code Red" massive blood loss protocol in cardiothoracic surgery showed improved adherence to guidelines between 2015 and 2018. Enhanced preparation and timely blood product delivery contributed to safer patient care.
Area of Science:
- Cardiothoracic Surgery
- Hematology
- Patient Safety
Background:
- Massive blood loss (MBL) is a critical complication in cardiothoracic surgery.
- The 'Code Red' protocol was implemented to manage MBL according to established guidelines.
- A closed-loop audit was performed to assess protocol adherence and patient outcomes.
Purpose of the Study:
- To evaluate the adherence of the 'Code Red' MBL protocol to local and national guidelines.
- To assess the impact of protocol implementation on patient care and outcomes.
- To identify areas for improvement in MBL management within a specialist cardiothoracic hospital.
Main Methods:
- Retrospective audit of electronic and paper patient records from 2015 and 2018.
- Comparison of 'Code Red' activations against national standards from The British Committee for Standards in Haematology.
- Evaluation of adherence to ten key standards in the hospital's MBL protocol.
Main Results:
- 'Code Red' activations decreased from 0.83% in 2015 to 0.26% in 2018.
- Significant improvements observed: 6% increase in appropriate activations, 26% increase in prompt hematology notification, 30% increase in timely blood product delivery.
- A 25% decrease in pre-activation blood transfusions was noted.
Conclusions:
- The 'Code Red' protocol demonstrated improved adherence to MBL management standards.
- Enhanced preparation and anticipation of MBL likely reduced protocol activations, ensuring safe patient care.
- Improvements were noted despite a reduced activation timeframe, indicating effective protocol refinement.
Aim:
To investigate if the massive blood loss protocol 'Code Red' at a specialist cardiothoracic hospital was activated according to local and national guidelines by a closed loop audit.
Methods:
Electronic and paper patient care systems were searched in 2015 and 2018 to access records for the 'Code Red' activations. Activation of the massive blood loss protocol was compared against the national standards set by The British Committee for Standards in Haematology. The percentage of cases meeting each of the ten standards in the specialist cardiac unit's Protocol for the Management of Massive Blood Loss in Adults (adapted from the national standards) were evaluated.
Results:
'Code Red' protocol was activated on 18 occasions in 2015 and nine occasions in 2018, representing just 0.83 and 0.26% of emergency surgeries, respectively. Between 2015 and 2018, there was a 6% increase of 'Code Red' cases being appropriately activated, a 26% increase in the prompt notification of the haematology department upon activation, alongside a 30% increase in the timely delivery of blood products, and a 25% decrease in the average amount of blood transferred prior to 'Code Red' activation.
Conclusion:
There has been an improvement in the standards of care and management of massive blood loss this specialist cardiac centre despite the target timeframe being reduced from 30 to 15min between 2015 and 2018. Preparation for and anticipation of massive blood loss has likely decreased the number of incidences requiring 'Code Red' activation, permitting delivery of safe patient care.
