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How did we reform our out of control massive transfusion protocol program?

Brian D Adkins1, Theresa A Libby2, Marlene M Mayberry2

  • 1Department of Pathology, University of Virginia School of Medicine, Charlottesville, Virginia, USA.

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|October 18, 2021
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Summary

A root cause analysis improved the massive transfusion protocol (MTP), reducing MTP activations and blood product waste. This optimization enhanced resource utilization and decreased stress on transfusion services.

Keywords:
managementmassive transfusion protocolsqualitytransfusion practice

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Area of Science:

  • Transfusion Medicine
  • Healthcare Management

Background:

  • Massive transfusion protocol (MTP) activation increased over tenfold between 2008 and 2015 at an academic medical center.
  • This rise placed significant stress on the transfusion service.

Purpose of the Study:

  • To reform the existing massive transfusion protocol (MTP) in response to increased activation frequency.
  • To identify key areas for improvement within the MTP.

Main Methods:

  • A multidisciplinary root cause analysis (RCA) was conducted with numerous stakeholders.
  • Four principal opportunities for improvement (OFI) were identified: education, stewardship, process improvement, and communication.

Main Results:

  • Implementation of new approaches targeting the identified OFIs led to reduced MTP activations.
  • Blood product waste and stress on transfusion service technologists were significantly decreased.
  • The MTP became better aligned with its intended purpose of rapidly supporting exsanguinating patients.

Conclusions:

  • The massive transfusion protocol (MTP) is improvable through systematic analysis.
  • Root cause analysis (RCA), while time-intensive, yields substantial benefits including improved communication, reduced stress, and optimized resource utilization.
  • Reformed MTP enhances efficiency and patient care alignment.