Improving RBC inventory by optimizing preoperative ordering and eliminating crossmatch and hold

Blood product constraints have increased the focus on inventory management as blood banks have faced challenges that impact supply chains and donor availability. Solutions often include a reduction in transfusion volumes through multidisciplinary improvements, but this is often coupled with a reduction in blood bank inventory to match reduced demand. We sought to improve inventory availability within the blood bank without modification of transfusion rates through solutions that prevented unnecessary RBC orders and crossmatching.

Improvements were focused on reduction of duplicate orders, preoperative blood orders, excess volume of blood orders, and crossmatching in advance of perioperative needs. The study monitored the improvement of the crossmatch to transfusion ratio as the primary outcome and days of shelf life until expiration as a secondary outcome.

The CT ratio of RBCs decreased from 2.03 (16,044/7922) pre-implementation to 1.67 (12,321/7375) post-implementation (p < 0.05). Our inventory was managed more efficiently following our interventions as demonstrated through the day of shelf life of RBCs issued. Pre-implementation, RBCs were issued an average of 17.5 days before expiration, which increased to 20.4 days post-implementation (p < 0.05).

Modification of preoperative order sets and education of clinical staff to ensure appropriate blood product ordering can significantly impact available inventory. Although this was also identified within our study, we found that the largest impact comes from a change in crossmatching workflow to reduce unnecessary reserving of RBCs. These changes can be implemented without significant impact to turnaround time.