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When every second counts: How a simulation dramatically improved blood delivery times for trauma patients

Toronto, August 13, 2018

By Amber Daugherty

The trauma team runs through a massive transfusion protocol simulation
The trauma team runs through a massive transfusion protocol simulation. (Photo by Yuri Markarov)

When a critically injured and bleeding patient is rushed into a trauma bay, every second counts – the faster they can receive blood, the higher their odds are of survival. So when St. Michael’s trauma team discovered unnecessary delays in getting blood from the blood bank to the trauma bay, they eliminated them. As a result, blood is being delivered on average 2.5 minutes faster – improving patients’ survival odds by 12.5 per cent.

“Two and a half minutes might not seem like a long time but it can feel like an eternity when you’re waiting for this critical treatment for a bleeding trauma patient,” said Dr. Andrew Petrosoniak, emergency physician and trauma team leader who was the senior author of the study working alongside lead author Dr. Alice Gray and collaborator Dr. Katerina Pavenski. “That’s why we started running simulations to look at our massive transfusion protocol (how we get blood to a trauma patient) – we wanted to identify areas for improvement.”

Using simulation in health care is one way teams can identify issues and test changes before any patient is impacted. They can be done in situ – meaning in the actual clinical environment – to make them feel more real. In this case, they were done right in the trauma bay; the team was activated as though there was a real trauma patient and they went through their normal processes – the only difference was that there was a manikin (simulation version of a mannequin) in the bed instead of a patient. After each simulation, they would debrief to talk about what happened and what they could do better.

Infographic: EVERY SECOND COUNTS - Using simulations, the trauma team identified three opportunities to move blood faster from teh blood bank to the trauma bay - A nurse makes one phone call to Locating to request a porter. Locating then forwards them to the blood bank. Previously, the nurse would have had to make separate phone calls. - Blood is delivered 2.5C faster - Once the porter picks up the blood from the blood bank, they follow a standard route to the trauma bay. Previously, each porter would take their own route to get there, so delivery times would vary. - Survival odds are increased by 12% - There is a designated drop-off spot in the trauma bay for the blood where the porters go when they arrive. Previously, it was unclear who porters should speak with and where they should put the blood.
Click in on image above to see a larger version of the infographic

“Simulation is all about recreating a real situation in a safe and controlled environment,” said Nazanin Khodadoust, manager of the Allan Waters Family Simulation Centre. “It’s a proactive approach that allows us to identify where and why potential incidents might occur and make necessary improvements long before actual patients are involved.”

Within the first few simulations, the team found three issues that meant blood wasn’t being delivered to the trauma patient as quickly as it could be.

“When there’s a trauma, our nurses have to let the blood bank know and they also have to request a porter to deliver the blood to the trauma bay,” said Dr. Petrosoniak. “That’s two phone calls – we identified that as a potential risk because with everything else going on, they could forget to make one of those calls.”

The interprofessional team, including Lee Barratt, ED nurse educator, and Yvonne Davis-Read, transfusion safety nurse, changed the process to require just one phone call – a nurse would call locating to request a porter, who would then forward them to blood bank to prepare and release blood products. In the process, they discovered an IT issue – the trauma phone, because of its emergency purpose, couldn’t be forwarded, so it would drop the call.

“If we weren’t running through this scenario, we could have waited a long time until somebody identified this dropped call issue, ultimately affecting patient care,” said Dr. Petrosoniak. “But because of the simulation, we were able to fix this in 24 hours and it didn’t negatively impact a single trauma patient.”

The team also identified that porters weren’t following a consistent route from the blood bank to the trauma bay so even though the two units are just a floor away from each other, delivery times would vary. And once they arrived, porters didn’t know where to go or who to give the blood to. As a result, there’s now a standard route for porters to take and a designated drop-off spot once they arrive.

“This was so significant because it shows we can do testing and quality improvement without impacting any patients,” said Dr. Petrosoniak, who presented the study’s findings at the annual congress of the International Society of Blood Transfusion in June. “It’s a way to crash test the system just like you would crash test a car to make sure it’s as safe and effective as possible. This allowed us to iron out the kinks so that by the time real trauma patients were involved, the only impact they were more likely to see was better outcomes.”

Providing safe care is one of our quality improvement goals – see all of them.

About St. Michael's Hospital

St. Michael’s Hospital with Providence Healthcare and St. Joseph’s Health Centre now operate under one corporate entity as of August 1, 2017. United, the three organizations serve patients, residents and clients across the full spectrum of care, spanning primary care, secondary community care, tertiary and quaternary care services to post-acute through rehabilitation, palliative care and long-term care, while investing in world-class research and education.


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