While investigating a recent spate of mislabelling incidents, we incidentally found quite a few instances of unutilized Group and Crossmatch (GXM) samples sent from the Emergency Department (ED) resulting in wastage. This resulted in the department  incurring manpower, time and monetary costs with the added risks of possible errors and healthcare works being exposed to blood-borne illnesses. 

These GXM samples are valid for only 72h for procurement of blood products for patients, after which a new sample would have to be drawn if further blood products are required. 

From the physician’s perspective, time taken to draw these wasted samples can be better used for other clinical duties and realistically fewer GXM draws translate to reduced opportunities for catastrophic GXM errors and exposure to blood-borne illnesses. Not only do patients have to expend unnecessary blood for these wasted GXM samples, they are also charged about S$29 for each sample. The Blood Bank also wastes about 40 minutes processing each of these unutilized GXM samples, using up time and efforts of lab staff and machines and exposing them unnecessarily to risks of errors and disease.

An audit of all GXM samples sent from ED in July 2023 was carried out to quantify the extent of GXM sample wastage, elicit possible contributing factors and generate possible solutions. 

919 GXM samples were sent in July 2023, of which only 158 (17%) were utilized to procure blood products. Analyzing the samples sent in the first 2 weeks, of the 440 GXM samples sent from the ED, 364 GXM samples (83%) were left unutilised (refer to Fig.1). 

Going through the indications, 280 samples (64%) were considered appropriate sends – including pre-existing critical care bundles for trauma, cerebrovascular accidents, gastrointestinal bleeds, active bleeding and cytopenia requiring transfusion. The remaining 160 samples (36%) were found to be unnecessary and were sent for ED visits for hypoglycemia, pneumonia, cholecystitis, gastroenteritis to name a few. 

Our review showed a high proportion of unutilized GXM samples sent from ED, representing waste of healthcare resources and unnecessary exposure to potential errors and blood-born illnesses.  We aim to reduce this by 10% and created guidelines for GXM sampling in the ED (ref to Fig.2) – which were implemented from 1st Oct 2023. 

Going forward, further data analysis is planned to follow this intervention to review the usefulness of this guideline after implementation and relevance of workflow related GXMs.