The Crossmatch/Issue Ratio

Yazer, Mark H.; Alcantara, Ramir; Beizai, Pouneh; Draper, Norman R.; Harm, Sarah; Kutner, José Mauro; Lin, David; Pogłód, Ryszard; Rogers, Thomas S; Sørensen, Claess Henning; Sprogøe, Ulrik; Welbig, Julie; Yuen, Joyce; Ziman, Alyssa; Collaborative, Biomedical Excellence for Safer Transfusions

doi:10.1093/ajcp/aqw107

Cited by 7 publications

(5 citation statements)

References 5 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Studies typically did not provide data on the number of units crossmatched before delivery; therefore, we could not report transfusion service quality indicators, such as the crossmatch-to-transfusion and crossmatch-to-issue ratio. 12,53,54 The results of our study are specific to studies published in countries with developed economies; therefore, our findings are not generalizable to countries with developing economies. The method of accreta diagnosis varied widely between studies, with some requiring pathologic confirmation for inclusion and others diagnosing based on clinical factors.…”

Section: Discussioncontrasting

confidence: 63%

Red Blood Cell Transfusion in Patients With Placenta Accreta Spectrum

Miller

Leonard

Meza

et al. 2022

Obstetrics &Amp; Gynecology

View full text Add to dashboard Cite

To evaluate red blood cell use during delivery in patients with placenta accreta spectrum.DATA SOURCES: We searched MEDLINE, EMBASE, CI-NAHL, Cochrane Central, ClinicalTrials.gov, and Scopus for clinical trials and observational studies published between 2000 and 2021 in countries with developed economies.METHODS OF STUDY SELECTION: Abstracts (n54,275) and full-text studies (n5599) were identified and reviewed by two independent reviewers. Data on transfused red blood cells were included from studies reporting means and SDs, medians with interquartile ranges, or individual patient data. The primary outcome was the weighted mean number of units of red blood cells transfused per patient. Between-study heterogeneity was assessed with an I 2 statistic. Secondary analyses included red blood cell usage by placenta accreta subtype. TABULATION, INTEGRATION, AND RESULTS:Of the 599 full-text studies identified, 20 met criteria for inclusion in the systematic review, comprising 1,091 cases of placenta accreta spectrum. The number of units of red blood cells transfused was inconsistently described across studies, with five studies (25.0%) reporting means, 11 (55.0%) reporting medians, and four (20.0%) reporting individual patient data. The weighted mean number of units transfused was 5.19 (95% CI 4.12-6.26) per patient. Heterogeneity was high across studies (I 2 591%). In a sensitivity analysis of five studies reporting mean data, the mean number of units transfused was 6.61 (95% CI 4.73-8.48; n5220 patients). Further quantification of units transfused by placenta accreta subtype was limited due to methodologic inconsistencies between studies and small cohort sizes.CONCLUSION: Based on the upper limit of the CI in our main analysis and the high study heterogeneity, we recommend that a minimum of 6 units of red blood cells be available before delivery for patients with placenta accreta spectrum. These findings may inform future guidelines for predelivery blood ordering and transfusion support.

show abstract

Section: Discussioncontrasting

confidence: 63%

Red Blood Cell Transfusion in Patients With Placenta Accreta Spectrum

Miller

Leonard

Meza

et al. 2022

Obstetrics &Amp; Gynecology

View full text Add to dashboard Cite

show abstract

“…The issue‐to‐transfusion ratio provides a useful metric for future quality improvement efforts focused on perioperative blood delivery. While the crossmatch‐to‐transfusion ratio has become a widely accepted quality and effectiveness metric, it is less relevant in the era of electronic crossmatch (i.e., for antibody‐negative patients, crossmatch orders are performed electronically only when the issue request is received) 20,21 . Measuring the ratio of units issued to the operating rooms to units transfused is a better indicator of the effectiveness of surgical blood issue orders, 3 because electronic crossmatching takes little time and effort, while issuing blood and processing returns requires substantial time and effort 2 .…”

Section: Discussionmentioning

confidence: 99%

“…While the crossmatch-to-transfusion ratio has become a widely accepted quality and effectiveness metric, it is less relevant in the era of electronic crossmatch (i.e., for antibody-negative patients, crossmatch orders are performed electronically only when the issue request is received). 20,21 Measuring the ratio of units issued to the operating rooms to units transfused is a better indicator of the effectiveness of surgical blood issue orders, 3 because electronic crossmatching takes little time and effort, while issuing blood and processing returns requires substantial time and effort. 2 In our non-cardiovascular operating rooms, we were able to achieve an issue-to-transfusion ratio approaching 1:1 by building clinician trust in a reliable on-demand blood delivery system via a pneumatic tube system.…”

Section: Discussionmentioning

confidence: 99%

Reducing perioperative red blood cell unit issue orders, returns, and waste using failure modes and effects analysis

et al. 2023

View full text Add to dashboard Cite

Background Surgical transfusion has an outsized impact on hospital‐based transfusion services, leading to blood product waste and unnecessary costs. The objective of this study was to design and implement a streamlined, reliable process for perioperative blood issue ordering and delivery to reduce waste. Study Design and Methods To address the high rates of surgical blood issue requests and red blood cell (RBC) unit waste at a large academic medical center, a failure modes and effects analysis was used to systematically examine perioperative blood management practices. Based on identified failure modes (e.g., miscommunication, knowledge gaps), a multi‐component action plan was devised involving process changes, education, electronic clinical decision support, audit, and feedback. Changes in RBC unit issue requests, returns, waste, labor, and cost were measured pre‐ and post‐intervention. Results The number of perioperative RBC unit issue requests decreased from 358 per month (SD 24) pre‐intervention to 282 per month (SD 16) post‐intervention (p < .001), resulting in an estimated savings of 8.9 h per month in blood bank staff labor. The issue‐to‐transfusion ratio decreased from 2.7 to 2.1 (p < .001). Perioperative RBC unit waste decreased from 4.5% of units issued pre‐intervention to 0.8% of units issued post‐intervention (p < .001), saving an estimated $148,543 in RBC unit acquisition costs and $546,093 in overhead costs per year. Discussion Our intervention, designed based on a structured failure modes analysis, achieved sustained reductions in perioperative RBC unit issue orders, returns, and waste, with associated benefits for blood conservation and transfusion program costs.

show abstract

“…Future studies should examine transfusion service quality indicators (such as the crossmatch-to-transfusion and crossmatch-to-issue ratio). 23–25…”

Section: Discussionmentioning

confidence: 99%

“…Future studies should examine transfusion service quality indicators (such as the crossmatch-totransfusion and crossmatch-to-issue ratio). [23][24][25] It is possible that the implementation of less stringent blood ordering recommendations may result in more frequent use of emergency-release blood products and, secondarily, recipient alloimmunization. However, the transfusion rate of emergency-release blood products from a massive transfusion protocol in obstetrics is extremely low (0.09-0.21%).…”

Section: Clinical Implications Transfusion Preparednessmentioning

confidence: 99%

Current State and Future Direction of Postpartum Hemorrhage Risk Assessment

Ende¹,

Butwick²

2021

Obstetrics &Amp; Gynecology

View full text Add to dashboard Cite

In the United States, postpartum hemorrhage is a leading preventable cause of maternal mortality and morbidity. To reduce morbidity from postpartum hemorrhage, risk assessment is an important starting point for informing decisions about risk management and hemorrhage prevention. Current perinatal care guidelines from the Joint Commission recommend that all patients undergo postpartum hemorrhage risk assessment at admission and after delivery. Three maternal health organizations—the California Maternal Quality Care Collaborative, AWHONN, and the American College of Obstetricians and Gynecologists’ Safe Motherhood Initiative—have developed postpartum hemorrhage risk-assessment tools for clinical use. Based on the presence of risk factors, each organization categorizes patients as low-, medium-, or high-risk, and ties pretransfusion testing recommendations to these categorizations. However, the accuracy of these tools' risk categorizations has come under increasing scrutiny. Given their low positive predictive value, the value proposition of pretransfusion testing in all patients classified as medium- and high-risk is low. Further, 40% of all postpartum hemorrhage events occur in low-risk patients, emphasizing the need for early vigilance and treatment regardless of categorization. We recommend that maternal health organizations consider alternatives to category-based risk tools for evaluating postpartum hemorrhage risk before delivery.

show abstract

The Crossmatch/Issue Ratio

Abstract: Electronic crossmatching is common, and the C/I ratio can be an indicator of efficiency.

Cited by 7 publications

References 5 publications

Red Blood Cell Transfusion in Patients With Placenta Accreta Spectrum

Red Blood Cell Transfusion in Patients With Placenta Accreta Spectrum

Reducing perioperative red blood cell unit issue orders, returns, and waste using failure modes and effects analysis

Current State and Future Direction of Postpartum Hemorrhage Risk Assessment

Contact Info

Product

Resources

About