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Reducing the Time to Blood Administration after Pediatric Injury: A Quality Improvement Initiative
Travis M Sullivan1, Zachary P Milestone1, Emily C Alberto1
1Division of Trauma and Burn Surgery, Children's National Hospital, Washington, D.C.
Insights
Relocating un-crossmatched blood storage to the emergency department (ED) significantly reduced transfusion time in pediatric trauma patients. This system-based intervention is crucial for improving timely blood administration in critical care settings.
Area of Science:
- Pediatric Trauma Care
- Emergency Medicine
- Transfusion Medicine
Background:
- Hemorrhage is a leading cause of preventable death in pediatric trauma.
- Timely blood administration is critical for improving outcomes in injured children.
- Identifying and mitigating transfusion delays is essential for pediatric resuscitation.
Purpose of the Study:
- To identify factors contributing to blood transfusion delays in injured children.
- To implement interventions aimed at reducing the time to blood administration.
- To evaluate the impact of these interventions on transfusion timeliness and likelihood.
Main Methods:
- A multidisciplinary team identified transfusion delay factors.
- Interventions included relocating un-crossmatched blood to the ED, implementing an IV access algorithm, and establishing a nursing educator role.
- Comparative and regression analyses were used to assess intervention impact.
Main Results:
- The study treated 2159 injured children between January 2017 and June 2021.
- Placing blood storage in the ED reduced the adjusted time-to-blood administration by 11 minutes (to 17 minutes).
- No significant change in transfusion likelihood or time reduction was observed with the IV algorithm or nursing educator.
Conclusions:
- Relocating un-crossmatched blood storage to the ED effectively decreased transfusion time.
- This system-based intervention is a valuable strategy for reducing transfusion delays in time-critical pediatric trauma care.
Introduction:
Hemorrhage is the leading cause of preventable death in pediatric trauma patients. Timely blood administration is associated with improved outcomes in children and adults. This study aimed to identify delays to transfusion and improve the time to blood administration among injured children.
Methods:
A multidisciplinary team identified three activities associated with blood transfusion delays during the acute resuscitation of injured children. To address delays related to these activities, we relocated the storage of un-crossmatched blood to the emergency department (ED), created and disseminated an intravenous access algorithm, and established a nursing educator role for resuscitations. We performed comparative and regression analyses to identify the impact of these factors on the timeliness and likelihood of blood administration.
Results:
From January 2017 to June 2021, we treated 2159 injured children and adolescents in the resuscitation area, 54 (2.5%) of whom received blood products in the ED. After placing a blood storage refrigerator in the ED, we observed a centerline change that lowered the adjusted time-to-blood administration to 17 minutes (SD 11), reducing the time-to-blood administration by 11 minutes (β = -11.0, 95% CI = -22.0 to -0.9). The likelihood of blood administration was not changed after placement of the blood refrigerator. We observed no reduction in time following the implementation of the intravenous access algorithm or a nursing educator.
Conclusions:
Relocation of un-crossmatched blood storage to the ED decreased the time to blood transfusion. This system-based intervention should be considered a strategy for reducing delays in transfusion in time-critical settings.
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