Reducing perioperative red blood cell unit issue orders, returns, and waste using failure modes and effects analysis

Area of Science:

• Transfusion Medicine
• Healthcare Operations
• Patient Safety

Background:

• Surgical transfusions significantly impact hospital transfusion services, causing blood product waste and increased costs.
• High rates of surgical blood issue requests and red blood cell (RBC) unit waste were observed at an academic medical center.

Purpose of the Study:

• To design and implement a streamlined, reliable process for perioperative blood issue ordering and delivery.
• The goal was to reduce waste and associated costs in hospital transfusion services.

Main Methods:

• A failure modes and effects analysis systematically examined perioperative blood management practices.
• A multi-component action plan included process changes, education, electronic decision support, and feedback.
• Changes in RBC unit issue requests, returns, waste, labor, and cost were measured pre- and post-intervention.

Main Results:

• Perioperative RBC unit issue requests decreased by 21%, from 358 to 282 per month.
• The issue-to-transfusion ratio decreased from 2.7 to 2.1.
• Perioperative RBC unit waste dropped from 4.5% to 0.8%, saving an estimated $148,543 in acquisition costs and $546,093 in overhead annually.

Conclusions:

• A structured failure modes analysis-based intervention achieved sustained reductions in perioperative RBC unit issue orders, returns, and waste.
• The intervention demonstrated significant benefits for blood conservation and transfusion program cost-effectiveness.