NYU Grossman school of medicine; SBH Health System New York, New York, United States
Background/Case Studies: Since July 2018, our institution has pursued continuous improvement of the Massive Transfusion Protocol (MTP) to enhance patient care and reduce blood product wastage. Recognizing the complexity of MTP activations, we implemented a series of targeted, multidisciplinary strategies to improve process compliance and operational efficiency.
Study
Design/Methods: A retrospective study was conducted to assess MTP process compliance from 2019 to 2024. Basic MTP process compliance was defined by completion of the following steps: (1) placement of a notification call to the blood bank at MTP initiation, (2) A runner with a pickup slip or label to the blood bank, and (3) notification call to the blood bank upon MTP termination.
Over the years, several interventions were introduced to support the compliance, including:
Revision of MTP package contents to better align with clinical needs.
Regular MTP drills conducted by the blood bank in collaboration with ICUs, trauma, emergency, and surgical departments.
Development of a visual blood poster, initially designed by a trauma physician and later refined by the Emergency Department through collaboration with blood bank.
Implementation of MTP downgrading protocols to emergency transfusion when clinically appropriate.
Retrospective reviews of MTP activations at Patient Blood Management (PBM) and transfusion committee meetings.
High-level MTP case reviews led by the Chief Medical Officer, involving all relevant departments to identify gaps and reinforce best practices.
Results/Findings: Our review demonstrates a significant upward trend in MTP process compliance, rising from 27% in 2019 to 72% in 2024 (Figure A). Despite these process enhancements, the annual number of MTP activations has remained relatively stable, ranging from 55 to 67 events per year. This improvement reflects the cumulative impact of sustained education, interdepartmental collaboration, and leadership engagement.
Conclusions: Our experience demonstrates that a structured, multidisciplinary approach—supported by leadership, regular training, and continuous feedback—can lead to meaningful and sustained improvements in MTP process compliance. These efforts are essential for optimizing transfusion practices and improving outcomes in critical bleeding scenarios.
