Biomaterial Database

Are changes in admission practices for elective surgery posing a transfusion threat to patients? 2002

S Chiganti, and F Regan

Hammersmith Hospitals NHS Trust, National Blood Service, North London, UK.

There is an increasing emphasis on reducing in-patient hospital stay for elective surgical procedures. As a result, pre-operative stay has shortened, with less time available for performing baseline investigations before surgery, including those required to ensure a supply of safe, compatible blood. We have estimated the frequency of failure to complete 'group and screen' (G&S) testing before surgery where indicated, so that neither group-compatible blood nor crossmatched blood could be provided promptly if an unexpected haemorrhage occurs. Retrospective data were obtained from elective surgical procedures performed over a 3-week period. Of the 309 procedures performed, 21 patients were exposed to the risk of failure to provide appropriately matched blood had an emergency arisen. (In 20, a G&S was required; in one, a crossmatch was required.) Late samples and lack of information on the request form regarding the date and time of surgery were the main causes. Procedures requiring G&S only as opposed to crossmatch posed the greatest risk. Urgent measures are needed to ensure that, where indicated, a pre-operative G&S result is available before surgery begins. Educating colleagues, redesigning request forms and improving out-of-hour laboratory services and hospital information systems are the main steps needed to reduce this latent risk.

UI	MeSH Term	Description	Entries
D011300	Preoperative Care	Care given during the period prior to undergoing surgery when psychological and physical preparations are made according to the special needs of the individual patient. This period spans the time between admission to the hospital to the time the surgery begins. (From Dictionary of Health Services Management, 2d ed)	Care, Preoperative,Preoperative Procedure,Preoperative Procedures,Procedure, Preoperative,Procedures, Preoperative
D001788	Blood Grouping and Crossmatching	Testing erythrocytes to determine presence or absence of blood-group antigens, testing of serum to determine the presence or absence of antibodies to these antigens, and selecting biocompatible blood by crossmatching samples from the donor against samples from the recipient. Crossmatching is performed prior to transfusion.	Blood Typing,Crossmatching, Blood,Blood Grouping,Blood Crossmatching,Grouping, Blood,Typing, Blood
D001803	Blood Transfusion	The introduction of whole blood or blood component directly into the blood stream. (Dorland, 27th ed)	Blood Transfusions,Transfusion, Blood,Transfusions, Blood
D006760	Hospitalization	The confinement of a patient in a hospital.	Hospitalizations
D006801	Humans	Members of the species Homo sapiens.	Homo sapiens,Man (Taxonomy),Human,Man, Modern,Modern Man
D012189	Retrospective Studies	Studies used to test etiologic hypotheses in which inferences about an exposure to putative causal factors are derived from data relating to characteristics of persons under study or to events or experiences in their past. The essential feature is that some of the persons under study have the disease or outcome of interest and their characteristics are compared with those of unaffected persons.	Retrospective Study,Studies, Retrospective,Study, Retrospective
D012306	Risk	The probability that an event will occur. It encompasses a variety of measures of the probability of a generally unfavorable outcome.	Relative Risk,Relative Risks,Risk, Relative,Risks,Risks, Relative
D017558	Elective Surgical Procedures	Surgery which could be postponed or not done at all without danger to the patient. Elective surgery includes procedures to correct non-life-threatening medical problems as well as to alleviate conditions causing psychological stress or other potential risk to patients, e.g., cosmetic or contraceptive surgery.	Surgical Procedures, Elective,Elective Surgical Procedure,Procedure, Elective Surgical,Procedures, Elective Surgical,Surgical Procedure, Elective
D019300	Medical Errors	Errors or mistakes committed by health professionals which result in harm to the patient. They include errors in diagnosis (DIAGNOSTIC ERRORS), errors in the administration of drugs and other medications (MEDICATION ERRORS), errors in the performance of surgical procedures, in the use of other types of therapy, in the use of equipment, and in the interpretation of laboratory findings. Medical errors are differentiated from MALPRACTICE in that the former are regarded as honest mistakes or accidents while the latter is the result of negligence, reprehensible ignorance, or criminal intent.	Medical Mistakes,Surgical Errors,Critical Incidents, Medical,Critical Medical Incidents,Errors, Medical,Errors, Surgical,Medical Error of Commission,Medical Error of Omission,Medical Errors of Commission,Medical Errors of Omission,Medical Mistake,Mistake, Medical,Mistakes, Medical,Never Event,Surgical Error,Wrong-Patient Surgery,Wrong-Procedure Errors,Wrong-Site Surgery,Commission Medical Error,Commission Medical Errors,Critical Incident, Medical,Critical Medical Incident,Error, Medical,Error, Surgical,Error, Wrong-Procedure,Errors, Wrong-Procedure,Event, Never,Events, Never,Incident, Critical Medical,Incident, Medical Critical,Incidents, Critical Medical,Incidents, Medical Critical,Medical Critical Incident,Medical Critical Incidents,Medical Error,Medical Incident, Critical,Medical Incidents, Critical,Never Events,Omission Medical Error,Omission Medical Errors,Surgeries, Wrong-Patient,Surgeries, Wrong-Site,Surgery, Wrong-Patient,Surgery, Wrong-Site,Wrong Patient Surgery,Wrong Procedure Errors,Wrong Site Surgery,Wrong-Patient Surgeries,Wrong-Procedure Error,Wrong-Site Surgeries