Cleveland Clinic Foundation Cleveland, Ohio, United States
Background/Case Studies: Balancing service work and education is an ongoing challenge in resident training. In the blood bank, one difficulty is the frequency and type of pages residents receive. Pages can lead to learning experiences for residents and some non-educational pages are expected, but pages that are too frequent can become burdensome. Our institution has a busy blood bank service, averaging 15-18 pages per day persistently over seven years. The frequency of non-educational pages made the blood bank rotation stressful to residents and impeded their learning. Efforts were made to decrease unnecessary pages, and focus calls on medically necessary and educational situations.
Study
Design/Methods: To assess distribution of pages prior to making changes, the resident call log was audited over a four-month period by two investigators who categorized calls by topic. This revealed the most frequently addressed issues were platelet triaging, massive transfusion protocols, irradiation requests, transfusion reactions, antigen negative red blood cell (RBC) units and samples/serology. From this analysis, efforts were made to decrease the frequency of pages on these topics. Standing platelet orders were reevaluated and the number of platelets ordered increased, massive transfusion protocol procedure was changed so residents would only be paged after a third cooler of units was issued (later increased to a fifth), all irradiation requests became retrospective reviews, and issues of serology and sampling were rerouted to technologist supervisors and a second supervisor was hired to assist in these issues. Changes to the transfusion reaction request system remain in process.
Results/Findings: The targeted areas showed a significant positive response to the changes. Total pages received decreased from 5,298 the year prior to 3,565 the year after implementation. This reduced pages per day from 15 to 10. The frequency of calls related to irradiation and serology/sample ordering decreased by 89.0%, calls related to antigen-negative RBC units decreased by 71.7%, calls involving massive transfusion protocol issues decreased by 65.0% and platelet triage call frequency decreased by 55.1%.
Conclusions: The adoption of targeted improvements decreased the overall number pages to the resident service, particularly in the areas identified for changes. The benefits of this change include allowing residents to spend more time on education and engagement with more complex clinical questions. Residents report a much more positive impression of the blood bank rotation and blood bank as a specialty. It has an additional benefit to technologists in the blood bank in that the reduced reliance on resident involvement for ordinary calls has allowed the technologists to continue their work uninterrupted.
