Mayo Clinic Florida Jacksonville, Florida, United States
Background/Case Studies:
Background:
To allow quick access to blood in time-constrained situations, RBC units are set up prior to a transfusion order for patients with known antibodies (Abs) and low hemoglobin (Hb in g/dL). Regardless of the results of a Type and Screen (TS), if the patient is outpatient, has a history of Abs, and the Hb meets the threshold, two compatible antigen (Ag) negative RBC units are crossmatched (XM) with the current TS. This is done without a Prepare Order by using Downtime cards (DTC), where XM results are written on the DTC and units placed on a corresponding shelf. If requested, units are taken from DTC and selected (SL) in the blood bank Laboratory Information System. XM results are input at selection, making blood available with minimal wait time. When DTC were first introduced, the Hb threshold was 9.0 and changed to 7.9 to streamline the DTC process.
Study
Design/Methods: Methods:
DTC from January 2024 to April 2025 were analyzed to assess the monetary change from a Hb threshold of 9.0 to 7.9. Information from the DTC were put in Excel, including the Hb of each patient, the type of XM done like Indirect Antiglobulin Testing or Electronic XM, the number of XM units taken from DTC and SL, and the number of negative Ag screened for the patient. “Negative Ag charge” refers to the testing to find Ag negative RBC units corresponding to a patient’s Ab required for XM.
Results/Findings:
Results:
From January to August 2024, 562 DTC were made with the Hb threshold of 9.0. A total of 1,451 negative Ag were screened for patients amounting to $320,671 (Figure A). The XM and the negative Ag charge are only billed to the patient if a Prepare Order is received and the unit is SL; it is not billed if it stays on DTC. The total XM charge, including billed and unbilled, was $238,782. Of this, $146,326 in XM were not billable due to 61% of DTC (345/562) having no unit SL. A total of 517.5 hours or $22,532 of labor was associated with the non-billable DTC.
The new Hb of 7.9 from September 2024 to April 2025 made 540 DTC. A total of 1,297 negative Ag were screened, saving $34,034 from the total Ag charge (Figure A). Less XM units saved $14,298 from the total XM charge. The greatest change occurred when the number of DTC with no unit SL dropped to 40%, saving $56,532 in unbilled XM. A lower Hb threshold produced fewer cards and saved 193.5 hours or $8,425 of labor in this process. Conclusions:
Conclusion:
Changing the Hb threshold from 9.0 to 7.9 not only reduced costs in preparing DTC, it made the DTC preparation more efficient. With fewer DTC set up, the unbilled XM charge decreased due to a higher percentage of units being SL. This shows the lower threshold produced tighter control over the process and less wastage of units and labor. An additional area of study would be to investigate patient impact if the DTC process were further simplified.
