Background/Case Studies: Process improvements are necessary in a busy blood bank. Trying to incorporate assays that give value to the physician and improve patient care is critical. As staffing constraints drive the testing model, so does cost. Over the years there was a need to streamline processes when implementing automation to eliminate unnecessary assays. One such assay eliminated was the manual autocontrol (AC) in favor of an automated Direct Antiglobulin Test with IgG coombs (DAT-IG). This was a retrospective review to determine the cost based on labor, reagents, turnaround time (TAT) and workflow comparison for AC and DAT-IgG.
Study
Design/Methods: The retrospective study compared TAT, labor and cost per test for an AC vs. DAT-IG. A review of the workflow for automated DAT-IG compared to manual AC with hemagglutination (TUBE) was included. Averaged time for two techs to perform the assays were incorporated in the TAT.
Results/Findings: Previous workflow included an AC with every antibody Identification (ABID) performed. The current automation platform included two Echo Lumena (Werfen, Norcross, GA) and manual reagents for DAT/AC (Werfen, Norcross, GA). Streamlining the process allowed the facility to only perform manual AC when ABID was positive for all donor cells, panagglutination (PAN) & to determine if a possible autoantibody would be sent to the reference lab. Otherwise, the process included an automated DAT-IgG for any patient without a previous history of an antibody. If DAT-IgG was positive an eluate sample would be performed on the analyzer. All DAT/IgG negative results were reported as such. Only requested TUBE DAT-Poly were performed and if positive, differentiation between IgG/C3d was performed. This workflow resulted in ~92 automated DAT-IgG and ~10% PAN AC annually. Eliminating the AC with every ABID, saved 80% labor and 70% overall cost, with only a slightly longer TAT (4 min.). See Table 1. Automation was implemented 8 years ago, and based on this workflow, no negative impact has been observed.
Conclusions: Reviewing workflows and incorporating new processes may be needed over time. Streamlining assays for improved workflow allows for faster TAT and better patient care. Often transfusion services previously perform AC with every patient’s ABID and then proceeded to DAT testing. By implementing DAT-IgG initially, it resulted in less wasted labor (80%) and cost savings (70%). The TAT was 4 minutes longer but did not require hands-on testing, nor additional testing as previously seen when an AC was performed and then followed with the DAT assay. Having implemented this process 8 years ago, we observed no negative impact and better patient care. Implementing an automated DAT complement assay in the future, would potentially bring additional standardization and more labor savings.
