Details

Autor(en) / Beteiligte

• Drapeau, Annie I.
• Parker, William
• Townsend, Stephanie
• Pearson, Gregory D.

Titel

Improving the timely availability of blood products for patients undergoing craniosynostosis surgery

Ist Teil von

• Perioperative care and operating room management, 2021-12, Vol.25, p.100207, Article 100207

Ort / Verlag

Elsevier Inc

Erscheinungsjahr

2021

Quelle

Alma/SFX Local Collection

Beschreibungen/Notizen

• Blood transfusions are common in craniosynostosis surgery and it is critical that packed red blood cells (pRBCs) be available prior to the start of surgery due to the risk of massive hemorrhage during surgical exposure. At our institution, timely availability of pRBCs was inconsistent due to suboptimal pre-operative care coordination. Our aim was to increase the availability of pRBCs before general anesthesia induction, from 47.5% to 100%, in patients undergoing craniosynostosis surgery, by June 2020. QI methodology adapted from the Institute for Healthcare Improvement (IHI model) was used to improve the process of pre-operative preparation of these patients. A multidisciplinary team was convened to develop a streamlined preoperative pathway to ensure patients had pRBCs available for surgery. The pathway included ensuring patients have their blood type and screen (T&S) drawn within our hospital system and implementing a weekly electronic communication to provide an opportunity to identify patient issues and problem-solve prior to surgery. The main outcome measure was pRBCs availability prior to time of intubation. The timing of blood T&S draw and surgery start time delays were measured as process and balancing measures, respectively. An increase in the percentage of craniosynostosis patients with pRBCs available before endotracheal intubation was associated with a centerline shift from an average of 47.5% for the baseline period, to 96.7% (P < .001) by July 2020. The percentage of patients with a blood T&S completed at least 1 hour before the endotracheal intubation increased from a mean of 57.4% for the baseline period, to 100% (P < .001) during the QI initiative period. Lastly, these interventions did not affect the rate of delayed surgeries which remained at the 22.95% baseline through July 2020. Implementation of a multidisciplinary approach to pre-operative care coordination led to a meaningful improvement in the timely availability of pRBCs for patients undergoing craniosynostosis surgery.