P‐TS‐18 | Collecting a Pre‐Operative Type and Screen Anywhere in the System

Abstract

A 25-hospital system in the Midwest had historically required patients to have pre-operative (Pre-OP) Type and Screen (TAS) specimens collected at the hospital where surgery was to be performed. This originally was needed due to separate medical record numbers (MRNs) for each hospital location. With the transition to an integrated Hospital Informatics System (HIS), one MRN is now being used. The move to a single MRN presented an opportunity for collection of TAS samples at any hospital location within the system. Pre-OP samples were also extended from 14 to 21 days with the new process. Each sample needs to meet the criteria for an extended outdate. Questions needed to be asked at the time of collection to determine if the patient had been transfused or pregnant in the past 3 months. A template was created for the collections team to ask questions at the time specimens were collected. If no TAS was collected prior to surgery, a TAS was often sent STAT on the day of surgery. This requires the lab to prioritize these samples and potentially delay surgery if the antibody screen was positive. An antibody identification can take from 2 to 8 h to complete plus additional time to find compatible blood. Collecting the TAS ahead of time gives the transfusion service the opportunity to complete the work up on a non-STAT basis and have the needed blood products available prior to surgery. Questions asked at Collection 1) What hospital location will surgery be taking place? 2) What is the planned date of surgery? 3) Have you been transfused or pregnant in the past 3 months? Clarification was added, if currently pregnant then the question would be answered “Yes.” Also included a statement that if the answer to the last question was “Yes” then the TAS should not be collected and to reschedule the collection 3 days prior to the surgery date. New process was implemented the beginning of February 2022. With the ability to have the pre-op TAS collected up to 21 days prior to surgery at any of our hospital or clinic sites, we no longer receive complaints from patients regarding the inconvenience and we also avoid receiving Type and Screen (TAS) samples on the day of surgery. Data was obtained from the largest hospital in the system for Same Day Surgery STAT TAS testing. Annual pre-implementation had a range of 6 to 21 (Average 11.2) samples/month compared to post-implementation range of 0 to 4 (Average 1.8) samples/month. The ability to travel to any of our hospital locations to have specimens collected and adding 7 days to the specimen outdate makes it more convenient for the patients to have the TAS samples collected. These changes have resulted in a decreased number of Same Day Surgical STAT samples and a better experience for the patient.

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