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Bleeding emergencies in neonatal and paediatric patients: improving the quality of care using simulation
Author(s) -
Delaney M.,
Roberts J.,
Mazor R.,
TownsendMcCall D.,
Saifee N. H.,
Pagano M. B.,
Matthews D. C.,
Stone K.
Publication year - 2018
Publication title -
transfusion medicine
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.471
H-Index - 59
eISSN - 1365-3148
pISSN - 0958-7578
DOI - 10.1111/tme.12562
Subject(s) - medicine , multidisciplinary approach , emergency medicine , emergency department , quality management , medical emergency , blood product , surgery , operations management , management system , social science , psychiatry , sociology , economics
Summary Objectives Using a multidisciplinary approach and simulation, a massive transfusion process (MTP) was developed to care for patients in need of emergency transfusion. It was then assessed for effectiveness. Background After a series of sentinel emergency bleeding events, a reliable process for hospital staff to deliver appropriate blood products and obtain relevant laboratory tests to guide therapy for patients with emergency bleeding was needed. Methods To determine the feasibility of the new MTP, multidisciplinary teams participated in simulation events. Each simulation event helped refine the MTP. A special laboratory testing panel was devised. To judge the effectiveness and timeliness of the MTP, process measures and patient survival was retrospectively evaluated during the time period before and after MTP implementation. Results A new emergency bleeding panel of laboratory tests significantly decreased the turn‐around time for fibrinogen, haematocrit, International normalised ratio (INR) and platelet count. The speed of commencing the first red blood cells transfusion was also improved (2:00 h vs 0:20 min, P = 0·001). Of 78 patients, there was no change in survival before ( n = 31, 48·4%) and after ( n = 47, 42·6%; P = 0·6478) MTP implementation. However, there was significant improvement in survival associated with MTP events on the weekdays. Conclusions A reliable emergency transfusion process consists of an automatic chain of events that keeps decision‐making to a minimum and leads to the fast procurement of blood products and salient test results. This work shows that a multidisciplinary iterative process using simulation increases the efficiency of clinical care delivery for bleeding paediatric and neonatal patients.