Performance Improvement Program Review of Institutional Massive Transfusion Protocol Adherence: An Opportunity for Improvement.
Am Surg
; 90(5): 1082-1088, 2024 May.
Article
em En
| MEDLINE
| ID: mdl-38297889
ABSTRACT
BACKGROUND:
Given the acuity of patients who receive MTPs and the resources they require, MTPs are a compelling target for performance improvement. This study evaluated adherence with our MTP's plasmared blood cell ratio (FFPR) of 12 and plateletred blood cell ratio (PLTR) of 112, to test the hypothesis that ratio adherence is associated with lower inpatient mortality. MATERIALS ANDMETHODS:
The registry of an urban level I trauma center was queried for adult patients who received at least 6 units of packed red blood cells within 4 hours of presentation. Patients were excluded for interfacility transfer, cardiac arrest during the prehospital phase or within one hour of arrival, or for head AIS ≥5. Univariate analysis and multiple logistic regressions were performed to identify variables associated with early transfusion protocol noncompliance and the effect on inpatient mortality.RESULTS:
Three hundred and eighty-three patients were included, with mean ISS of 25.9 ± 13.3 and inpatient mortality of 28.5%. Increasing age, ISS, INR, and total units of blood product transfused were associated with increased odds of mortality, while an increase in revised trauma score was associated with a decreased odds ratio of mortality. Achieving our goal ratios were protective against mortality, with OR of .451 (P = .013) and .402 (P=.003), respectively.DISCUSSION:
Large proportions of critically injured patients were transfused fewer units of plasma and platelets than our MTP dictated; failure to achieve intended ratios at 4 hours was strongly associated with inpatient mortality. MTP processes and outcomes should be critically assessed on a regular basis as part of a mature performance improvement program to ensure protocol adherence and optimal patient outcome.Palavras-chave
Texto completo:
1
Coleções:
01-internacional
Base de dados:
MEDLINE
Assunto principal:
Ferimentos e Lesões
/
Transfusão de Sangue
Tipo de estudo:
Prognostic_studies
Aspecto:
Implementation_research
Limite:
Adult
/
Humans
Idioma:
En
Revista:
Am Surg
Ano de publicação:
2024
Tipo de documento:
Article
País de afiliação:
Estados Unidos