Impact of a Type and Screen Protocol on Surgical Blood Utilization Indices: A Retrospective Pre- and Post-Implementation Study at Vajira Hospital
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Abstract
Objectives: To evaluated the impact of type and screen protocol for surgical blood management by comparing three blood utilization indices, the proportion of inadequate preoperative crossmatches, and the incidence of blood incompatibility before and after protocol implementation.
Materials and Methods: This retrospective pre- and post-protocol study analyzed anesthetic records and blood reservation data of adult inpatients in 11 departments who underwent elective surgeries at Vajira Hospital between November 2020 and April 2021 (pre-protocol group) and between August 2021 and January 2022 (post-protocol group). Three blood utilization indices, namely, crossmatch-to-transfusion (C/T) ratio, transfusion probability (%T), and transfusion index (Ti), were calculated for each department and overall, then compared to international benchmarks. Multilevel mean difference regression was utilized to investigate the protocol’s impact on three indices, as well as on the percentage of inadequate preoperative crossmatch and transfusion mismatches.
Results: The study included 1533 patients in the pre-protocol group and 1404 patients in the post-protocol group. Multivariable analysis adjusted for patient demographics, preoperative laboratory results, and intraoperative blood loss demonstrated significant improvements in the C/T ratio (mean difference (MD) -0.65, p < 0.01), %T (MD 34.1%, p < 0.01), and Ti (MD 0.5, p < 0.01) following protocol implementation. However, C/T ratios across all departments still failed to meet international benchmark. The proportion of inadequate preoperative crossmatches did not differ significantly between the two periods (MD -0.73, p = 0.15) and no blood incompatibilities were recorded in either group.
Conclusion: The type and screen protocol were associated with improved blood utilization efficiency for elective surgeries at Vajira Hospital without difference in percentages of underordering. While these observational findings are promising, C/T ratios failed to reach international standard. Further refinement of the protocol or the development of an institute-specific maximum surgical blood-order schedule is recommended.
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