A picture might be worth a thousand words, but the right label can save thousands of dollars.
By replacing text-heavy instruction labels for blood transport coolers with icon-driven labels, providers at the University of Florida (UF) College of Medicine have shown a dramatic reduction in blood product waste—saving their hospital almost $20,000 in just five months.
“Blood product waste is a multifactorial problem,” said Ashley Screws, MD, an anesthesiologist at the UF College of Medicine and UF Health Shands Hospital, in Gainesville, “but by following the example set by the Mayo Clinic, we started with one simple intervention. These new transport cooler labels, which better illustrate the proper handling of blood products, have saved the hospital a lot of money”.
As Dr. Screws reported at the 2016 annual meeting of the International Anesthesia Research Society (abstract S-289), a significant percentage of blood transfusions are given during surgery, requiring their delivery from and return to the hospital’s blood bank. Of the blood products that are wasted in the hospital setting, at least 70% of the loss can be attributed to the operating room (OR).
“We realized we were unnecessarily wasting a lot of blood product in our hospital,” Dr. Screws said. “Not only is there a dollar impact to the medical center; this also affects the availability of a precious resource to our patients, especially in emergencies.”
A Chilling Discovery
A multidisciplinary committee consisting of blood bank staff, anesthesiology staff and OR managers determined that a significant reason for blood product loss was units being stored and/or returned outside the required temperature range established by the American Association of Blood Banks.
“The No. 1 culprit for wasted blood product was a failure to properly handle the blood products being sent to the operating rooms of our busy Level 1 trauma and organ transplantation center,” Dr. Screws said. “We were returning unused blood product that was outside the required temperature range.”
The researchers were inspired by a Mayo Clinic study, which saved approximately $9,000 per month by changing its blood product transport labels and buying new coolers for its hospital (Transfusion 2014;54:701-707). Instead of going straight to purchasing new coolers, however, which would require a capital outlay, Dr. Screws decided to test the effect of a simple label change first. She and her team designed an icon-driven label to replace the text-heavy label that was often ignored.
The new transport cooler labels were implemented hospital-wide at the end of September 2015.
Dr. Screws, along with her co-investigators, Jeffrey White, MD, and J. Peter R. Pelletier, MD, chose to compare five similar calendar months of data to minimize seasonal variations in surgical volume, especially trauma.
The researchers compared data for blood product waste collected from October to November 2014 with October to November 2015, and waste collected from December 2014 to February 2015 with December 2015 to February 2016.
During October to November 2014, 235 blood product units were marked for waste, with 25.5% of these being returned to the blood bank outside of regulation temperature range, Dr. Screws reported. The total calculated cost of this waste was $8,717.
After implementation of the new transport labels for October to November 2015, however, 149 blood product units were wasted, with only 10.7% of these returned outside of regulation temperature range. Waste decreased to $3,178, for savings of more than $5,500 over the same time period.
During December 2014 to February 2015, 99 product units were marked for waste, with 34% of these being returned to the blood bank outside of regulation temperature range. The total calculated cost of this waste was $21,987. However, after implementation of the new protocol, for the period of December 2015 to February 2016, only 32 blood product units were wasted, with only 11 of these (34%) returned outside of regulation temperature range, Dr. Screws reported.
“The pre- and postimplementation quarterly data reveal a dramatic decrease in the number of wasted units and the associated costs after the new labels,” Dr. Screws said. “After implementation, waste decreased to $8,155, for savings of almost $14,000.”
The investigators also determined that during November 2015, not all the multiple hospital blood coolers had received the new cooler labels. Massive transfusion protocol blood products are dispensed in large transport coolers that did not all have the new labels until December 2015.
Despite the dramatic savings, the researchers are still brainstorming improvements, and have identified several changes that may favorably affect future results.
As Dr. Screws explained, new labeled bags will be designed for platelet transport to prevent them from being improperly placed inside coolers. In addition, she said, education of nurses and patient service technicians, who are responsible for retrieving and returning blood products, could further limit waste. Lastly, Dr. Screws and her colleague Dr. White have created an electronic medical record (EMR) pop-up reminder to encourage proper and timely blood product return.
“We’re very excited about our initial results,” said Dr. Screws, “but ultimately, our goal is zero waste of blood products in our hospital. … We still have a few things left to fix.”
Shanna Sykes Hill, MD, program director of the cardiothoracic anesthesiology fellowship at NewYork-Presbyterian Hospital/Weill Cornell Medical Center, in New York City, said the changes made by Drs. Screws and White are particularly effective in places like the ORs and ERs where blood utilization is often emergent and little time can be spared for reviewing long instructions.
“In today’s culture,” said Dr. Hill, “people are accustomed to icons and brief information bites, and this type of infographic is a quick and savvy way to grab attention and convey the bullet points. In combination with other changes, such as EMR pop-ups and text alerts to mobile devices, this could be highly efficacious.”