• Lawrence T Goodnough, Kay Daniels, Amy E Wong, Maurene Viele, Magali F Fontaine, and Alexander J Butwick.
• Department of Pathology and Medicine and Obstetrics and Anesthesiology, Stanford University School of Medicine, Stanford, California 94305, USA. ltgoodnough@stanfordmed.org
• Transfusion. 2011 Dec 1; 51 (12): 2540-8.

BackgroundObstetric services depend on the transfusion service (TS) to provide diagnostic testing and blood component therapy for clinical care pathways.Study Design And MethodsWe describe three quality improvement (QI) initiatives implemented to improve TS support of obstetric services.ResultsWe implemented a pathway for patients requiring an ABO/Rh order for every admission to obstetric services, along with reconciliation of the daily hospital birth manifest and TS umbilical cord log to identify every woman eligible for RhIG. After assessment over 6 months, 21 (1%) of 2041 women lacked an admission ABO/Rh; all subsequently had ABO/Rh determinations. Umbilical cords were missing for eight (0.4%) mothers; four were D- and received RhIG. We developed algorithms for diagnostic blood ordering for patients deemed at "low,"moderate," or "high" risk of blood transfusion. A 27% reduction in total diagnostic test volumes and 24% reduction in charges was documented after compared to before implementation. We analyzed the impact of our massive transfusion protocol (MTP) on blood inventory management for 31 (0.25%) women undergoing 12,945 deliveries, representing 11% of 286 MTPs for all clinical services over a 32-month interval. O- uncrossmatched red blood cells (RBCs) represented 103 (24%) of 421 RBC units issued. Wastage rates of RBCs, plasma, and platelets ordered and issued in the MTPs were 0.7, 16, and 3%, respectively.ConclusionQI initiatives for RhIG prophylaxis, diagnostic blood test ordering, and MTP improve TS support of obstetric services.© 2011 American Association of Blood Banks.

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