Background/Case Studies: Reducing platelet wastage is a significant challenge and a key objective for healthcare systems. Platelets have a short shelf-life and are expensive. The aim of this initiative at SBH Health System was to reduce or minimize platelet wastage by changing the ordering strategy and implementing new Blood Bank policies. Before implementing wastage reduction strategies (2010-2014), the average annual platelet wastage was 196 units.
Study
Design/Methods: A 15-year retrospective review was conducted to study the impact of changes to the standing order for platelets, changes to the Massive Transfusion Protocol (MTP), and the implementation of Code-H. The strategies included decreasing the platelet standing order from 2 Platelets 3 times a week to 1 Platelet 3 times a week, which was implemented in 2015; A new MTP policy was implemented in March 2017, changing the composition of MTP packs from every pack containing platelets (6 Red Blood cells:6 Plasma:1 Platelet) to every other pack containing platelets (pack#1, 4:4:1; pack#2, 4:4:0); A Code-H (Hemorrhage) policy was successfully implemented in February 2020, requiring less to no platelets. Ongoing monitoring involves checking the platelet standing order and cancelling it if platelets are leftover from MTP/Code-H activations, ordering platelets as needed.
Results/Findings: Since implementing the wastage reduction strategies in 2015, platelet wastage was managed to decrease consistently. From 2015 to 2024, the total platelet wastage was 994 units, averaging 99 units per year. This represents an average annual reduction of 97 units compared to the pre-implementation period (196 units average from 2010-2014). The total platelet wastage reduction over 10 years (2015-2024) is 970 units. Based on the minimum cost of $692 per unit, the potential platelet cost saving for 10 years is $671,240. A retrospective review concluded that these changes/implementations did not affect the treatment and/or patient outcome. Even with an increase in MTP activations from 30 in 2015 to 71 MTPs & 20 Code-H in 2024, the platelet wastage in 2024 was 68 units, which is well below the average of the last 10 years (99 units) (see Figure A).
Conclusions: The blood bank and multidisciplinary teams at SBH Health System successfully reduced platelet wastage by implementing three key strategies: modifying standing orders, changing the MTP protocol, and implementing the Code-H policy. These efforts resulted in a marked reduction in platelet wastage and substantial cost savings over a 10-year period, without negatively impacting patient outcomes.
