Challenges in reliable preoperative blood ordering: A qualitative interview study.

Autor: Yang P; Department of Anesthesiology, Washington University School of Medicine, St. Louis, Missouri, USA., Zijlstra EP; Department of Anesthesiology, Washington University School of Medicine, St. Louis, Missouri, USA., Hall BL; Department of Surgery, Washington University School of Medicine, St. Louis, Missouri, USA., Gregory SH; Department of Anesthesiology, Washington University School of Medicine, St. Louis, Missouri, USA., Jackups R Jr; Department of Pathology and Immunology, Washington University School of Medicine, St. Louis, Missouri, USA., Li J; Division of General Medical Sciences, Department of Medicine, Washington University School of Medicine, St. Louis, Missouri, USA., Abraham J; Department of Anesthesiology, Washington University School of Medicine, St. Louis, Missouri, USA.; Institute for Informatics, Data Science, and Biostatistics, Washington University School of Medicine, St. Louis, Missouri, USA., Lou SS; Department of Anesthesiology, Washington University School of Medicine, St. Louis, Missouri, USA.; Institute for Informatics, Data Science, and Biostatistics, Washington University School of Medicine, St. Louis, Missouri, USA.
Jazyk: angličtina
Zdroj: Transfusion [Transfusion] 2024 Oct; Vol. 64 (10), pp. 1889-1898. Date of Electronic Publication: 2024 Sep 16.
DOI: 10.1111/trf.18012
Abstrakt: Background: Presurgical blood orders are important for patient safety during surgery, but excess orders can be costly to patients and the healthcare system. We aimed to assess clinician perceptions on the presurgical blood ordering process and perceived barriers to reliable decision-making.
Methods: This descriptive qualitative study was conducted at a single large academic medical center. Semi-structured interviews were conducted with surgeons, anesthesiologists, nurse anesthetists, nurse practitioners working in preoperative assessment clinics, and transfusion medicine physicians to assess perceptions of current blood ordering processes. Interview responses were analyzed using an inductive open coding approach followed by thematic analysis.
Results: Twenty-three clinicians were interviewed. Clinicians felt that the current blood ordering process was frequently inconsistent. One contributor was a lack of information on surgical transfusion risk, related to lack of experience in ordering clinicians, insufficient communication between stakeholders, high turnover in academic settings, and lack of awareness of the maximum surgical blood ordering schedule. Other contributors included differing opinions about the benefits and harms of over- and under-preparing blood products, leading to variation in transfusion risk thresholds between clinicians, and disagreement about the safety of emergency-release blood.
Conclusion: Several barriers to reliable decision-making for presurgical blood orders exist. Future efforts to improve ordering consistency may benefit from improved information sharing between stakeholders and education on safe transfusion practices.
(© 2024 AABB.)
Databáze: MEDLINE
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