Implementation of Mobile Blood Storage Refrigerators Reduces Waste

Background/Case Studies: During hemorrhagic events, clinicians often stockpile blood products at the bedside. Abrupt ending of the massive transfusion protocol (MTP) and return of those products can result in temperature-related waste. RBCs are wasted if not maintained at refrigerated temperatures; plasma, because it is brought to 37 C for thawing, is inevitably wasted if not cooled to the required 1-6 C. We implemented the Hemoroam 15XL mobile blood storage refrigerators (MBRs) (Roemer Industries, Santee, CA) for high-volume transfusion events at our university health system, which includes 2 hospitals, a Level I trauma center, an obstetrics service and a liver transplant service (750 inpatient beds, transfusion volume: 23,000 RBC units annually). We evaluated the impact on blood product wastage.Study Design/Method: Approval and funding were obtained from the hospital administration, and 10 MBRs were purchased and validated. A new standard operating procedure (SOP) for the MBR was implemented, and our blood issuing SOP was updated. The MBRs were piloted with the liver transplant program, and usage was subsequently expanded to the entire health system, including MTPs and other high-volume transfusion events upon request. Stakeholders including the liver transplant team and operating room staff received training on using the MBRs. Usage trends and temperature-related waste of RBC and plasma units for 8 months before (August 2016 through March 2017 ) and after (August 2017 through March 2018) MBR implementation were evaluated.

Results/Finding: The new MBR system has been used 207 times at our institution between August 2017 and March 2018. Of these, 28 were for liver transplants, 92 for apheresis (either plasma or RBC exchange), 33 for trauma with the remaining 54 cases being used by other teams including emergency medicine, obstetrics and critical care. Usage of the MBRs increased over time, with an overall average of 0.95 times/day (range 0.2/day in September to 1.36/day in February). Temperature-related waste of RBCs and plasma, as a fraction of total RBCs and plasma issued, averaged 1.48% before implementation (range 0.8% to 3.0% per month) and 1.17% after implementation (range 0.7% to 1.7% per month). The rate decreased more for plasma (2.30% to 1.38%, 40% decrease) than RBCs (1.19% to 1.10%, 8% decrease). At a cost of $216 per red cell unit and $30 per plasma unit, the cost savings, based on the improvement in average wastage, is $938 per month, for a total of $7,506 over 8 months.

Conclusion: Implementation of MBRs for MTPs and other high-volume transfusions decreases temperature-related waste of blood products, largely by enabling thawed plasma to be returned to inventory. Benefits include saving technologist time to discard units and receive new units, and better stewardship of the donated products. The MBRs are being increasingly utilized by clinicians.