Process mapping as a framework to define critical care delivery steps in massive transfusion in trauma

The purpose of this quality improvement initiative was to use process mapping to identify the critical process steps for executing massive transfusion in trauma patients with hemorrhagic shock in an academic emergency department. Understanding the relationships and complexity of care delivery steps in massive transfusion is needed to inform the development of performance metrics and improve care delivery.

This process mapping exercise was conducted in the academic emergency department of a verified trauma center using the Institute for Healthcare Improvement framework. Interviews were conducted with emergency department staff members, including nurses, technicians, pharmacists, and blood bank staff. Data collection included structured stakeholder interviews and real-time observation of massive transfusion protocol deployment.

Seventeen interviews and real-time observations yielded 87 pages of interview text and 533 objects mapped. Two key clinical decision points were identified: the decision to transfuse and the decision to image. The process was segmented into initial protocol-based care and subsequent physician-driven care. High-level and mid-level process maps, incorporating swim lanes, were created to highlight the process steps to deliver of massive transfusion to trauma patient in our academic emergency department.

Process mapping resulted in the creation of an agreed upon standard process that outlines critical steps and distinct phases of care in delivery of the massive transfusion protocol. These findings provide benchmarks for future improvement work and performance measurement efforts.