Operating Room Blood Delivery Turnaround Time

2002 ◽  
Vol 126 (8) ◽  
pp. 909-914 ◽  
Author(s):  
David A. Novis ◽  
Richard C. Friedberg ◽  
Stephen W. Renner ◽  
Frederick A. Meier ◽  
Molly K. Walsh
Keyword(s):  
United States ◽  
Operating Room ◽  
Median Time ◽  
The United States ◽  
Blood Bank ◽  
Blood Component ◽  
Blood Components ◽  
Improvement Program ◽  
Delivery Times ◽  
Blood Banks

Abstract Objectives.—To determine the normative distribution of time elapsed for blood bank personnel to fill nonscheduled operating room (OR) blood component orders in hospital communities throughout the United States, and to examine hospital blood bank practices associated with faster blood component delivery times. Design.—Participants in the College of American Pathologists Q-Probes laboratory quality improvement program collected data prospectively on the times elapsed for blood bank personnel to fill nonscheduled emergent orders from hospital ORs for red blood cell (RBC) products, fresh frozen plasma (FFP), and platelets (PLTs). Participants also completed questionnaires describing their hospitals' and blood banks' laboratory and transfusion practices. Setting and Participants.—Four hundred sixty-six public and private institutions located in 48 states in the United States (n = 444), Canada (n = 9), Australia (n = 8), the United Kingdom (n = 4), and Spain (n = 1). Main Outcome Measures.—The median time elapsed between requests for blood components by OR personnel and the retrieval of those components by blood component transport personnel, and the median time elapsed between requests for blood components by OR personnel and the arrival of those components in ORs. Results.—Participants submitted data on 12 647 units of RBCs, FFP, and PLTs. The median aggregate request-to-retrieval turnaround times (TATs) for RBCs, FFP, and PLTs ranged from 30 to 35 minutes, and the median aggregate request-to-arrival TATs for RBCs, FFP, and PLTs ranged from 33 to 39 minutes. Most of the TAT was consumed by events occurring prior to, rather than after release of components from blood banks. Shorter prerelease TATs were associated with having surgical schedules that listed patients' names and procedures available to blood bank personnel prior to surgeries, and having adequate clotted specimens in the blood bank and completed type-and-screen procedures performed before requests for blood components were submitted to blood banks. Among the fastest-performing 10% of participants (90th percentile and above), request-to-retrieval TATs ranged from 12 to 24 minutes for the 3 blood components, whereas among the slowest-performing 10% of participants (10th percentile and below), request-to-retrieval TATs ranged from 63 to 115 minutes for the 3 components. Median TATs ranged from 33 to 37 minutes for the 3 components. Institutions with TATs in the fastest-performing 25th percentile more frequently stored cross-matched RBCs in the OR daily, stocked PLTs for unexpected surgical use, stored PLTs in or near the OR, and had laboratory rather than nonlaboratory personnel deliver components to the OR than did those institutions with TATs in the slowest-performing 25th percentile. Conclusions.—Hospital blood bank personnel can deliver blood components to the OR in slightly longer than 30 minutes, measured from the time that those units are requested by OR personnel. Practices aimed at saving time before components are released from blood banks will be more efficient in reducing overall TAT than those practices aimed at saving time after components are released from blood banks. Specific practices associated with shorter blood delivery TATs included providing blood bank personnel with access to the names of surgical patients potentially requiring blood components, having pretransfusion testing completed on those patients prior to surgery, having ample blood products on hand, and having laboratory personnel control blood product delivery.

BLOOD BANKS FACING HUNDREDS OF AIDS SUITS

PEDIATRICS ◽  
1989 ◽  
Vol 84 (4) ◽  
pp. A24-A24
Author(s):  
J. F. L.
Keyword(s):  
United States ◽  
Disease Control ◽  
Blood Supply ◽  
Screening Test ◽  
The United States ◽  
Blood Bank ◽  
Legal Issue ◽  
Blood Transfusions ◽  
Blood Banks ◽  
Aids Virus

Blood bank officials in the United States are sounding an alarm because they are facing hundreds of lawsuits from people stricken with AIDS after receiving transfusions. Issue of Screening Test The suits generally involve transfusions received before mid-1985, when blood banks started using a screening test that detects antibodies to the AIDS virus in the blood. The central legal issue involves negligence: before the screening test was entirely in place, were the blood banks negligent in their efforts to keep the virus out of the blood supply? The blood banks. . . say the AIDS threat was not fully understood immediately and it was not always clear that the tests would be reliable. Moreover, they say it was often impractical to move more rapidly. While the test has made the nation's blood supply much safer, Federal experts at the Centers for Disease Control in Atlanta estimate that 12,000 people now living in the United States have been infected with the AIDS virus in blood transfusions. Of these, 2,170 adults and 177 children have developed AIDS so far.

Quality Indicators of Fresh Frozen Plasma and Platelet Utilization

2002 ◽  
Vol 126 (5) ◽  
pp. 527-532 ◽  
Author(s):  
David A. Novis ◽  
Stephen Renner ◽  
Richard C. Friedberg ◽  
Molly K. Walsh ◽  
Andrew J. Saladino
Keyword(s):  
United States ◽  
Quality Indicators ◽  
The United States ◽  
Fresh Frozen Plasma ◽  
Blood Bank ◽  
Private Institutions ◽  
Improvement Program ◽  
Public And Private ◽  
Fresh Frozen ◽  
Frozen Plasma

Abstract Objective.—To determine the normative rates of expiration and wastage for units of fresh frozen plasma (FFP) and platelets (PLTs) in hospital communities throughout the United States, and to examine hospital blood bank practices associated with more desirable (lower) rates. Design.—In 3 separate studies, participants in the College of American Pathologists Q-Probes laboratory quality improvement program collected data retrospectively on the numbers of units of FFP and PLTs that expired (outdated) prior to being used and that were wasted due to mishandling. Participants also completed questionnaires describing their hospitals' and blood banks' laboratory and transfusion practices. Setting and Participants.—One thousand six hundred thirty-nine public and private institutions, more than 80% of which were known to be located in the United States. Main Outcome Measures.—Quality indicators of FFP and PLT utilization: the rates of expiration and wastage of units of FFP and PLTs. Results.—Participants submitted data on 8 981 796 units of FFP and PLTs. In all 3 studies, aggregate combined FFP and PLT expiration rates ranged from 5.8% to 6.4% and aggregate combined FFP and PLT wastage rates ranged from 2.0% to 2.5%. Among the top-performing 10% of participants (90th percentile and above), FFP and PLT expiration rates were 0.6% or lower and FFP and PLT wastage rates were 0.5% or lower. Among the bottom-performing 10% of participants (10th percentile and below), expiration rates were 13.8% or higher and wastage rates were 6.8% or higher. We were unable to associate selected hospital characteristics or blood bank practices with lower rates of FFP and PLT utilization. Conclusions.—The rates of FFP and PLT expiration and wastage vary greatly among hospitals in the United States. Hospital blood bank personnel are capable of achieving FFP and PLT expiration and wastage rates below 1%.

Racial and Sex Disparities in Trauma Outcomes Based on Geographical Region

2020 ◽  
pp. 000313482096006
Author(s):  
William Q. Duong ◽  
Areg Grigorian ◽  
Cyrus Farzaneh ◽  
Jeffry Nahmias ◽  
Theresa Chin ◽  
...  
Keyword(s):  
United States ◽  
The United States ◽  
Trauma Patients ◽  
Improvement Program ◽  
Trauma Outcomes ◽  
Risk Of Death ◽  
Hospital Access ◽  
Risk Of Mortality ◽  
Sex Disparities ◽  
Male Patients

Objectives Disparities in outcomes among trauma patients have been shown to be associated with race and sex. The purpose of this study was to analyze racial and sex mortality disparities in different regions of the United States, hypothesizing that the risk of mortality among black and Asian trauma patients, compared to white trauma patients, will be similar within all regions in the United States. Methods The Trauma Quality Improvement Program (2010-2016) was queried for adult trauma patients, separating by U.S. Census regions. Multivariable logistic regression analyses were performed for each region, controlling for known predictors of morbidity and mortality in trauma. Results Most trauma patients were treated in the South (n = 522 388, 40.7%). After risk adjustment, black trauma patients had a higher associated risk of death in all regions, except the Northeast, compared to white trauma patients. The highest associated risk of death for blacks (vs. whites) was in the Midwest (odds ratio [OR] 1.30, P < .001). Asian trauma patients only had a higher associated risk of death in the West (OR 1.39, P < .001). Male trauma patients, compared to women, had an increased associated risk of mortality in all four regions. Discussion This study found major differences in outcomes among different races within different regions of the United States. There was also both an increased rate and associated risk of mortality for male patients in all regions. Future prospective studies are needed to identify what regional differences in trauma systems including population density, transport times, hospital access, and other trauma resources explain these findings.

Volunteers: An Effective Medium for Delivering Therapeutic Lifestyle Interventions

2021 ◽  
pp. 089011712110625
Author(s):  
Lillian M. Kent ◽  
Paul M. Rankin ◽  
Darren P. Morton ◽  
Rebekah M. Rankin ◽  
Roger L. Greenlaw ◽  
...  
Keyword(s):  
United States ◽  
Chronic Disease ◽  
Lifestyle Modification ◽  
Density Lipoprotein ◽  
Blood Lipid ◽  
The United States ◽  
Analysis Of Covariance ◽  
Health Improvement ◽  
Improvement Program ◽  
Blood Lipid Profile

Purpose Lifestyle modification programs have been shown to effectively treat chronic disease. The Coronary Health Improvement Program has been delivered by both paid professional and unpaid volunteer facilitators. This study compared participant outcomes of each mode in the United States. Design Pre-/post-analysis of CHIP interventions delivered between 1999 and 2012. Setting Professional-delivered programs in Rockford Illinois 1999-2004 and volunteer-delivered programs across North America 2005-2012. Subjects Adults ≥21 years (professional programs N = 3158 34.3% men, mean age = 54.0 ± 11.4 years; volunteer programs N = 7115 33.4% men, mean age = 57.4 ± 13.0 years). Measures Body mass index, blood pressure (systolic and diastolic), blood lipid profile (total cholesterol, high-density lipoprotein, triglycerides, low-density lipoprotein), and fasting plasma glucose. Analysis Analysis of Covariance, with adjustment for age, gender, BMI change and baseline biometric and effect sizes. Results The professional-delivered programs achieved significantly greater reductions in BMI (.4%, P < .001) and HDL (1.9%, P < .001) and the volunteer-delivered programs achieved greater reductions in SBP (1.4%, P < .001), DBP (1.1%, P < .001), TC (1.4%, P = .004), LDL (2.3%, P < .001), TG (4.0%, P = .006), and FPG (2.7%, P < .001). However, the effect size differences between the groups were minimal (Cohen’s d .1-.2). Conclusions Lifestyle modification programs have been shown to effectively treat chronic disease. The Complete Health Improvement Program (CHIP) lifestyle intervention has been delivered by both paid professional and unpaid volunteer facilitators. This study compared selected chronic disease biometric outcomes of participants in each mode in the United States. It found volunteer-delivered programs do not appear to be any less effective than programs delivered by paid professionals, which is noteworthy as volunteers may provide important social capital in the combat of chronic disease.

scholarly journals Advances in the Management of Sepsis and the Understanding of Key Immunologic Defects

2011 ◽  
Vol 115 (6) ◽  
pp. 1349-1362 ◽  
Author(s):  
Lee P. Skrupky ◽  
Paul W. Kerby ◽  
Richard S. Hotchkiss
Keyword(s):  
United States ◽  
Intensive Care Unit ◽  
Critical Care ◽  
Intensive Care ◽  
Operating Room ◽  
The United States ◽  
Difficult Problem ◽  
Treatment Algorithms ◽  
New Treatment ◽  
Overall Mortality

Anesthesiologists are increasingly confronting the difficult problem of caring for patients with sepsis in the operating room and in the intensive care unit. Sepsis occurs in more than 750,000 patients in the United States annually and is responsible for more than 210,000 deaths. Approximately 40% of all intensive care unit patients have sepsis on admission to the intensive care unit or experience sepsis during their stay in the intensive care unit. There have been significant advances in the understanding of the pathophysiology of the disorder and its treatment. Although deaths attributable to sepsis remain stubbornly high, new treatment algorithms have led to a reduction in overall mortality. Thus, it is important for anesthesiologists and critical care practitioners to be aware of these new therapeutic regimens. The goal of this review is to include practical points on important advances in the treatment of sepsis and provide a vision of future immunotherapeutic approaches.

Benchmarks for the Durations of Ambulatory Surgical Procedures in Otolaryngology

2011 ◽  
Vol 120 (11) ◽  
pp. 727-731 ◽  
Author(s):  
Neil Bhattacharyya
Keyword(s):  
United States ◽  
Operating Room ◽  
Surgical Procedures ◽  
Ambulatory Surgery ◽  
Secondary Analysis ◽  
The United States ◽  
Tube Placement ◽  
The Mean ◽  
Room Time ◽  
Ambulatory Procedures

Objectives: I undertook to determine benchmarks and variability for the surgical times associated with ambulatory otolaryngological procedures in the United States. Methods: I examined the 2006 release of the National Survey of Ambulatory Surgery and extracted all cases of otolaryngological surgery in which one, and only one, otolaryngological procedure was performed. The mean surgical times and operating room times were determined for each procedure that met reliability criteria for their estimates. A secondary analysis was computed for tonsillectomy and for tonsillectomy plus adenoidectomy according to a patient age of greater than 12 years. Results: An estimated 1.68 ± 0.23 million otolaryngological procedures were analyzed as solitary procedures, including 507,000 cases of myringotomy with ventilation tube placement, 136,000 cases of tonsillectomy, and 429,000 cases of tonsillectomy plus adenoidectomy. The mean (±SE) surgical times were 8.0 ± 0.5, 23.9 ± 1.8, and 20.3 ± 0.8 minutes, respectively. The total operating room times were 17.6 ± 0.9, 48.2 ± 2.0, and 40.7 ± 1.1 minutes, respectively. Septoplasty with turbinectomy was the most common rhinologic procedure performed (48,000 cases analyzed) and had surgical and operating room times of 49.6 ± 4.78 and 79.8 ± 5.8 minutes, respectively. The surgical times for tonsillectomy and tonsillectomy plus adenoidectomy did not differ significantly in magnitude according to standard age cutoffs, although the operating room time was slightly (11.7 minutes) longer for tonsillectomy in patients more than 12 years of age (p = 0.034). Conclusions: The surgical times for the performance of the most common otolaryngological ambulatory procedures are remarkably consistent in the United States. Given the volume and consistency of these surgical procedures, they are ideal candidates for studies of cost and efficiency.

Collection and transfusion of blood and blood components in the United States, 1992

Transfusion ◽  
2003 ◽  
Vol 35 (10) ◽  
pp. 802-812 ◽  
Author(s):  
E.L. Wallace ◽  
W.H. Churchill ◽  
D.M. Surgenor ◽  
J. An ◽  
G. Cho ◽  
...  
Keyword(s):  
United States ◽  
The United States ◽  
Blood Components

Analysis of Inpatient and Emergency Department Serial Troponin Testing Intervals in the United States

2020 ◽  
Author(s):  
Andrew Fletcher ◽  
Erik Forsman ◽  
Brian R Jackson
Keyword(s):  
United States ◽  
Emergency Department ◽  
Median Time ◽  
Emergency Departments ◽  
The United States ◽  
Published Data ◽  
Time Interval ◽  
Time Intervals ◽  
Convenience Sample ◽  
Facility Level

Abstract Background Serial measurement of cardiac troponins (cTn) is central to the diagnosis of myocardial infarction. The time intervals between individual measurements may impact the speed and reliability of diagnosis. Published recommendations exist for these time intervals, but there is little previously published data on actual intervals in routine clinical settings. Methods Retrospective analysis of cTn testing intervals was performed from a convenience sample of 37 hospitals. All 37 provided data on inpatient tests and 19 also provided separate data for tests ordered in their emergency departments. Facilities included both academic and community hospitals across the United States. For each facility, the median time interval between serial cTn order collections was determined separately for inpatient orders and emergency department orders. Results The facility-level median time intervals between serial inpatient cTn test orders ranged from 3.17 to 7.32 hours. Facility-level median time intervals between serial emergency department cTn orders ranged from 1.48 to 4.23 hours. There was no observed difference between academic and nonacademic facilities. Conclusion Typical time intervals between serial cTn orders varied widely across hospitals, and in many cases reflected suboptimal care. Time intervals were generally shorter for cTn testing ordered in emergency departments. Existing testing protocols should be re-examined.

Body Banks: A History of Milk Banks, Blood Banks, and Sperm Banks in the United States

2011 ◽  
Vol 12 (4) ◽  
pp. 749-760 ◽  
Author(s):  
Kara W. Swanson
Keyword(s):  
United States ◽  
The United States ◽  
The Body ◽  
Past Century ◽  
Sperm Bank ◽  
Blood Banks ◽  
History Of ◽  
Considerable Controversy ◽  
Milk Banks ◽  
Cord Blood Banks

My dissertation traces the invention and development of a new form of banking, body banking. Today, the body bank as an institution that collects, stores, processes, and distributes a human body product is a taken-for-granted aspect of medicine in the United States. We donate to blood banks, we cherish sperm bank babies, and we contemplate many sorts of banks, including cord blood banks, gene banks, and egg banks. Such institutions have existed for the past century in the metaphorical shadow of financial banks, and like those better-studied banks have stirred considerable controversy. The driving question behind my dissertation is simply, why banks? How did we come to use “bank” to apply to bodies as well as to dollars? More intriguingly, what does this analogy show us and what is it hiding?

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