A Comprehensive Strategy for an Emergency Action Plan to Support Patient Transfusion Needs During Extreme Blood Shortage

ABSTRACT

Background/Case Studies A national blood shortage resulted in the stringent allocation of blood resources below standard operating levels, beginning October 2021. A robust emergency action plan (EAP) was necessary to manage operations and support patient care. The comprehensive approach and final plan are reported here. Study Design/Methods: The transfusion committee, hospital CMOs, transfusion directors, ethics officer, and legal counsel developed a comprehensive emergency action plan (EAP) for the 3 hospital health system. Critical elements were identified for a tiered EAP based the percent of product in inventory compared to optimal non-shortage levels. Input from clinical divisions coupled with a communication plan were needed as operational capabilities could change unpredictably. The High Blood Utilization Plan (HBUP) using an in-house critical care physician team was created to rapidly assess ongoing heavy blood use such as transplant or MTP patient trajectory and ongoing blood need. A triage team for scarce resources, developed for COVID pandemic care allocation, was briefed on the potential for triaging blood in a manner as defined by NC state law. Information technology (IT) developed an inventory level dashboard using a visual analytics platform as well as reports to quickly identify patients with competing transfusion needs, defined as active RBC transfusion orders and ECMO patients. Provisions for sharing blood resources among the 3 hospitals were included. Perioperative planning reviewed the real time inventory dashboard daily to streamline OR scheduling and provide standardized decision support for case delays or cancellations. The dashboard also allow patient transfers to be informed of current operating status. Results/Findings: From 12/2021 to 2/2022 the EAP functioned in the critical tier with the exception of 1 day at panic tier. The HBUP was used on 2 occasions, however no triage decisions for competing blood needs occurred. Conclusion(s) The creation of an EAP coordinated across a 3 hospital health system was created to operationalize tiered care during an extreme blood shortage. The success of this plan was dependent on IT resources with strong communication to execute the required decisions. This plan remains available for future emergency use.