Massive blood loss protocol 'Code Red' at Papworth Hospital: A closed loop audit.

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.