Transfusion Preparedness in the Labor and Delivery Unit: An Initiative to Improve Safety and Cost.

Obstet Gynecol

Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, the Department of Pathology, and the Department of Anesthesiology, University of Utah Health, Intermountain Healthcare, and ARUP Laboratories, Salt Lake City, Utah; the Department of Anesthesia & Perioperative Medicine, Mayo Clinic, Rochester, Minnesota; and the Department of Value Engineering and the Division of Epidemiology, Department of Internal Medicine, University of Utah, Salt Lake City, Utah.

Published: November 2021

Objective: To evaluate patient safety, resource utilization, and transfusion-related cost after a policy change from universal type and screen to selective type and screen on admission to labor and delivery.

Methods: Between October 2017 and September 2019, we performed a single-center implementation study focusing on risk-based type and screen instead of universal type and screen. Implementation of our policy was October 2018 and compared 1 year preimplementation with 1 year postimplementation. Patients were risk-stratified in alignment with California Maternal Quality Care Collaborative recommendations. Under the new policy, the blood bank holds a blood sample for processing (hold clot) on patients at low- and medium-risk of hemorrhage. Type and screen and crossmatch are obtained on high-risk patients or with a prior positive antibody screen. We collected patient outcomes, safety and cost data, and compliance and resource utilization metrics. Cost included direct costs of transfusion-related testing in the labor and delivery unit during the study period, from a health system perspective.

Results: In 1 year postimplementation, there were no differences in emergency-release transfusion events (4 vs 3, P>.99). There were fewer emergency-release red blood cell (RBC) units transfused (9 vs 24, P=.002) and O-negative RBC units transfused (8 vs 18, P=.016) postimplementation compared with preimplementation. Hysterectomies (0.05% vs 0.1%, P=.44) and intensive care unit admissions (0.45% vs 0.51%, P=.43) were not different postimplementation compared with preimplementation. Postimplementation, mean monthly type and screen-related costs (ABO typing, antibody screen, and antibody workup costs) were lower, $9,753 compared with $20,676 in the preimplementation year, P<.001.

Conclusion: Implementation of selective type and screen policy in the labor and delivery unit was associated with projected annual savings of $181,000 in an institution with 4,000 deliveries per year, without evidence of increased maternal morbidity.

Download full-text PDF

Source
http://dx.doi.org/10.1097/AOG.0000000000004571DOI Listing

Publication Analysis

Top Keywords

type screen
20
labor delivery
8
delivery unit
8
safety cost
8
resource utilization
8
universal type
8
preimplementation year
8
year postimplementation
8
antibody screen
8
rbc units
8

Similar Publications

Want AI Summaries of new PubMed Abstracts delivered to your In-box?

Enter search terms and have AI summaries delivered each week - change queries or unsubscribe any time!