Electronic patient identification for sample labeling reduces wrong blood in tube errors.

BACKGROUND: Wrong blood in tube (WBIT) errors are a preventable cause of ABO-mismatched RBC transfusions. Electronic patient identification systems (e.g., scanning a patient's wristband barcode before pretransfusion sample collection) are thought to reduce WBIT errors, but the effectiveness of these systems is unclear. STUDY DESIGN AND METHODS: Part 1: Using retrospective data, we compared pretransfusion sample WBIT rates at hospitals using manual patient identification (n = 16 sites; >1.6 million samples) with WBIT rates at hospitals using electronic patient identification for some or all sample collections (n = 4 sites; >0.5 million samples). Also, we compared WBIT rates after implementation of electronic patient identification with preimplementation WBIT rates. Causes and frequencies of WBIT errors were evaluated at each site. Part 2: Transfusion service laboratories (n = 18) prospectively typed mislabeled (rejected) samples (n = 2844) to determine WBIT rates among samples with minor labeling errors. RESULTS: Part 1: The overall unadjusted WBIT rate at sites using manual patient identification was 1:10,110 versus 1:35,806 for sites using electronic identification (p < 0.0001). Correcting for repeat samples and silent WBIT errors yielded overall adjusted WBIT rates of 1:3046 for sites using manual identification and 1:14,606 for sites using electronic identification (p < 0.0001), with wide variation among individual sites. Part 2: The unadjusted WBIT rate among mislabeled (rejected) samples was 1:71 (adjusted WBIT rate, 1:28). CONCLUSION: In this study, using electronic patient identification at the time of pretransfusion sample collection was associated with approximately fivefold fewer WBIT errors compared with using manual patient identification. WBIT rates were high among mislabeled (rejected) samples, confirming that rejecting samples with even minor labeling errors helps mitigate the risk of ABO-incompatible transfusions.

Use of fresh-frozen plasma in 2012 at the Fondazione Ca' Granda Hospital of Milan: assessment of appropriateness using record linkage techniques applied to data routinely recorded in various hospital information systems.

BACKGROUND: The Quality Unit of a research and teaching hospital in Milan assessed the increased clinical use of fresh-frozen plasma in patients treated during 2012 in order to evaluate the appropriateness of this use. MATERIALS AND METHODS: For each patient in the study, a pathology profile was generated by means of record linkage techniques involving data collected through different information systems. Patients' information was combined using the patient identifier key generating pathology profiles exported to an Excel file. The profiles were reviewed by two haematologists who identified 101 potentially inappropriate treatments for which the medical records had to be reviewed manually. RESULTS: In 2012, 490 patients were transfused and for 473 cases the automatic record linkage provided a complete profile. The information relating to the remaining patients did not match, mainly because the patients underwent outpatient procedures for which clinical information is not automatically recorded. In the overall audit only 13 treatments were judged inappropriate. DISCUSSION: Our study supports the view that record linkage techniques applied to data routinely recorded in different hospital information systems could be potentially extended to support clinical audits, enabling the generation of automated patient profiles that can be easily evaluated, relegating manual checks on medical records to doubtful cases only. Moreover, the method applied in this study allows the analysis of a full set of cases instead of sample surveys, increasing the robustness of the audit results.