One of seven transfusion medicine performance indicators of The Joint Commission measures completion of pretransfusion blood type and antibody testing prior to elective surgery. In this report, the authors analyzed transfusion events reported through their common medical event reporting system of 8 networked hospitals over a 12 month period, and identified 12 patients who went to the operating room (OR) with incomplete pretransfusion testing and therefore no crossmatched blood available. Three mechanisms were identified to account for delays in completing pretransfusion testing: 1) in 6/12 instances, pretransfusion specimens had been drawn only on day of surgery and patients were taken into the OR while the blood bank was still testing their sample; 2) in 4/12 patients, pretransfusion testing had been ordered before day of surgery, but blood specimens had not been received by the blood bank; and 3) in 2/12 patients, bedside procedures for obtaining pretransfusion diagnostic specimens had not been properly followed.
The methodology utilized in this study did not allow the authors to estimate occurrence rates for non-compliance in this Joint Commission performance indicator. Our own institution previously has reported that 19% of patients scheduled for elective surgery had specimens drawn for pretransfusion testing only on day of surgery; of these, patients with positive antibody screens and incomplete testing at time of surgery, comprised 0.3% of all elective surgery patients, for an incidence of 1 in 328 . Implementation of preoperative checklists that prohibit initiation of elective surgery until crossmatched blood is set up are variably effective; while one study reported this approach to improve compliance  our own assessment found that 68/90 (75%) patients underwent surgery prior to completion of antibody identification over a nearly 3 year interval , which is in the same range of non-compliance as the 6/12 (50%) reported in this current study. Quality management systems within the OR need to reinforce the importance of preoperative checklists and ‘timeouts’ to insure crossmatched blood availability and patient safety.
– Lawrence Tim Goodnough
1. Goodnough LT, Viele M, Fontaine M, et al.Quality management in the transfusion service: case studies in process improvement. Transfusion 2011;51:600-9.
2. Saxena S, Nelson JM, Osby M, Shah M, Kempf R, Shulman IA. Ensuring timely completion of type and screen testing and the verification of ABO/Rh status for elective surgical patients. Arch Pathol Lab Med 2007;131:576-81.
3. Goodnough LT. Operational, quality, and risk management in the Transfusion Service: lessons learned. Transfus Med Rev 2011; in press.