Changes in Coagulation Testing During a National Shortage of Blue-Top Tubes

Area of Science:

• Clinical Pathology
• Laboratory Medicine
• Healthcare Management

Background:

• The COVID-19 pandemic disrupted supply chains, leading to a nationwide shortage of blue-top tubes (BTTs).
• BTTs are critical for most non-point-of-care coagulation tests, impacting laboratory operations and patient care.
• Cedars-Sinai Medical Center's Department of Pathology and Laboratory Medicine sought to conserve BTTs while maintaining patient safety.

Purpose of the Study:

• To evaluate the effectiveness of interventions aimed at reducing blue-top tube (BTT) utilization.
• To assess the impact of these interventions on coagulation testing volumes and patient outcomes.
• To identify key factors contributing to successful BTT conservation efforts.

Main Methods:

• A retrospective quality improvement analysis was conducted over a 3-month intervention period.
• Coagulation testing and BTT utilization data were examined before and after intervention implementation.
• Patient safety was monitored for any adverse events related to the interventions.

Main Results:

• Average daily BTT use decreased by 15.2% (from 476 to 403), with a 43.3% reduction in the Emergency Department.
• Average daily coagulation assay volumes dropped by 17.5% (from 949 to 783).
• No adverse patient events were reported during the study period.

Conclusions:

• Interventions were most effective in divisions with strong management and communication.
• Successful navigation of the BTT shortage was attributed to timely actions and clear communication.
• Recommendations promote efficient coagulation assay use, reduced BTT consumption, and prevention of adverse events for patients with coagulopathic disorders.