Efficient blood testing in endourology
A transfusion dashboard initiative to minimize unnecessary type and screen tests
DOI:
https://doi.org/10.5489/cuaj.9451Keywords:
Blood Transfusion, Urology, Quality Improvement, Health Care Economics and OrganizationsAbstract
INTRODUCTION: Type and screen testing (T&S) is routinely performed preoperatively for many endoscopic procedures, despite low transfusion rates. While important, T&S can be costly, unnecessary, and burdensome for patients to obtain in a short timeframe due to expiry. We aimed to assess and reduce unnecessary T&S in a safe and collaborative manner through a transfusion dashboard. We assessed the effect of reduced testing on patient safety, cost, and the environment.
METHODS: This quality improvement study used the transfusion dashboard, a web-based, institutional platform tracking blood transfusion trends. During the observation phase (2016– 2019), procedure-specific preoperative T&S recommendations were developed. Following implementation of these recommendations in 2020, the incidence of T&S, perioperative transfusion rates, and rescue transfusion rates were assessed pre- and post-intervention using the Chi-squared test. Cost and environmental savings were also evaluated.
RESULTS: From 2016–2023, outcomes were tracked for 4375 pre-initiative and 2488 postinitiative patients who underwent endoscopic procedures. We found a statistically significant decrease in T&S following initiative implementation for transurethral resection of the prostate (TURP), percutaneous nephrolithotomy (PCNL), holmium enucleation of the prostate (HoLEP), and transurethral resection of bladder tumor (TURBT) by as much as 51.2%. There was no change in uncrossed or overall blood transfusions. Since the implementation of the initiative, $45 362.81 in testing materials were saved, and an associated reduction of 697 kg CO2 was observed.
CONCLUSIONS: Institutional- and procedure-specific testing guidelines decreased unnecessary tests, leading to improved resource stewardship, reduced cost, improved patient experience, and environmental savings. Initial modest cost savings and care improvements may be amplified safely in larger organizations and across more procedures.
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