In-Situ Simulation to Reduce Time-to-Blood in Major Obstetric Haemorrhage
INTRODUCTION
At St George’s Hospital, a tertiary obstetric unit within a major trauma centre and regional NHS Blood and Transplant hub, there are ~4000 deliveries a year
2.7% of deliveries result in a major obstetric haemorrhage (MOH) with estimated blood loss >1.5L
In a MOH, rapid access to blood is critical
Although laboratory-issued heamorrhage packs (“Pack A”) are commonly requested, delays were frequently observed before blood was available for transfusion
Four units of emergency group O RhD negative (O-ve) blood are stored in a theatre fridge near delivery suite and may provide faster access
In-situ simulation is an excellent way to identify system weaknesses and allows for processes to be improved (1)
AIM
1.To compare the time taken to obtain emergency O-ve blood vs laboratory-issued Pack A
2.Identify factors contributing to delays
METHODS
We conducted an in-situ MOH simulation together with the midwifery and transfusion laboratory teams.
BloodTrack® was used for transfusion checks.
Simulation design
Two midwives were deployed simultaneously:
Blood runner 1: collected emergency O-ve blood from the theatre blood fridge
Blood runner 2: collected Pack A from the transfusion laboratory
Outcomes measured
Time to blood ready for transfusion
Delays and human factors
Equipment issues
Walking distance to blood source using a GPS tracking app
RESULTS
Emergency O-ve blood from the theatre fridge was available 6x faster
Time to blood ready for transfusion:
Emergency O-ve blood 2.1 minutes vs Pack A 12.4 minutes
Distance matters
Emergency blood fridge return journey: ~ 100 metres
Blood bank return journey: ~ 840 metres
Proximity was a major contributor to delay reduction.
Additional findings
An initial emergency O-ve collection attempt was discounted because:
BloodTrack® wristband scanning was started unnecessarily
(required for Pack A, not O-ve)
BloodTrack® device was not charged, and a new device had to be located
This increased time to emergency O-ve collection to 7.7 minutes
DISCUSSION
In some MOH cases, immediate blood transfusion is essential.
Waiting for Pack A may introduce avoidable delay.
Key learning points
Use emergency O-ve blood earlier when rapid transfusion is required
Appropriately trained blood runner is allocated
Rehearse local transfusion pathways
Educate staff about different requirements for emergency O-ve and Pack A blood
Keep BloodTrack® devices charged and available
Crossmatch high-risk patients proactively where appropriate and keep blood products in nearby theatre fridge to avoid delays
CONCLUSION
When rapid transfusion is required: choose nearest O-ve blood first
In-situ simulation is a great tool to highlight modifiable human and system factors that can significantly reduce time-to-blood in MOH
