You get what you need: Implementation of electronic remote blood refrigerators to reduce inefficiencies in blood product allocation and massive transfusion protocol overactivation.

Abstract

Electronic remote blood issue using remote blood refrigerators has been shown to deter against excessive ordering of blood products by clinicians. Here we report on our experience implementing remote blood refrigerators in surgical and trauma settings, with a focus on shifts in massive transfusion protocol overactivation tendencies. We installed remote blood refrigerators in the operating room, intensive care unit, and emergency department. Clinical staff were trained in the appropriate use and integration of these refrigerators into patient care workflows. Remote blood refrigerator use in the operating room was analyzed from software-generated logs. Massive transfusion protocol activations over a 55-month period were collated from massive transfusion protocol requisition forms. In the first 6 months after their introduction, remote blood refrigerators performed 1714 electronic crossmatches and dispensed 173 red blood cell units to 93 surgical patients. The remaining 1541 (90%) crossmatches were not transfused, representing substantial savings in technologist work-hours. In the emergency department, the median rate of massive transfusion protocol overactivations dropped from 4 per month to 1 per month in the 15 months preceding and 40 months following remote blood refrigerator implementation (P = 9.92 ×10-5). Increased accessibility of blood products to clinicians through remote blood refrigerators led to improved efficiency in our blood product allocation process and substantially reduced the rate of massive transfusion protocol overactivation.