Assessment of Key Performance Indicator as a Quality Tool for Management of Urgent Transfusion Requests

ABSTRACT

Background/Case Studies Automated analysis of patients' immunohematology (ABO blood typing and Irregular Antibody Screening-IAS) is routinely performed at pre-established times (samples processed in batches every 1 h 30) in our service. However for urgent requests, it is necessary a faster approach. Therefore, a medical classification of all blood requests is performed and depending on these classifications the tests are performed immediately or in the 1 h 30 batches. Monitoring these processes ensures the quality and safety of the service considering that an increase in urgent requests directly impact the lab routine. In this study, we analyzed our 5-year experience transfusion urgencies through two kinds of KPI (Key Performance Indicator). Study Design/Methods: All Blood Transfusion requests are pre-classified by medical department according to its clinical urgency using colored tags. The yellow tag indicates transfusion requests mainly for surgery patients, who have samples collected within 72 h of the transfusion and presented a negative IAS. The blue tag indicates request for patients not previously registered in the blood bank or without IAS within 72 h. The % of each tag (yellow or blue) in relation to the total number of requests was analyzed monthly from 2017 to 2021 as a KPI. The maximum % accepted were 2.0% and 5.0% for yellow and blue KPI, respectively. The results were analyzed using the t test and p < 0.05 was considered significant. Results/Findings: The yellow KPI showed a gradual reduction from 2017 to 2021, and consequently an evolution was observed in the % of months in which the target was reached (see table below). For the blue KPI, a reduction was also observed, however, the goal was only reached in all the months of 2020. It was observed that statistic differences occurred between 2017/2018 (yellow KPI p = 0.01, blue KPI p = 0.03) and also for 2019/2020 (yellow KPI p = 0.04, blue KPI p = 0.01). In the first period (2017/2018) the reduction was attributed to medical/laboratory training to properly classifying the requests and, in the second period (2019/2020) besides a rigid follow up of the KPI, there was also a reduction in elective and emergency surgeries due to the situation imposed by the COVID-19 pandemic. Conclusion(s) According to the data shown, there was a significant reduction in urgent transfusion requests between 2017 and 2021. These decreases were only possible to be achieved through the systematic evaluation of the KPI. Thus, the use of this tool is extremely important to ensure the better management of the laboratory routine, especially in urgent situations, in which it directly contributes to ensuring the process safety.