Reducing blood preparation for total knee arthroplasty: A practical approach

Background & Problems: The rate of allogenic blood preparation for an elective total knee arthroplasty (TKA) has been as high as 100% at our institute. However, most (76.2%) of these preparations were wasted. Purpose: This project worked to reduce unnecessary blood preparations for this elective procedure and reduce resource expenditures. Resolutions: Key issues identified as requiring resolution included: Uncertainty regarding urgent transfusion need, insufficient preoperative evaluation of high risk patients, and the use of outdated clinical pathways. Measures taken to overcome these issues included redefining transfusion triggers using relevant empirical data as conclusive evidence and building a general consensus within the medical team while acquiring practical support from decision makers. A more comprehensive assessment process for identifying risk factors was developed by reviewing and assessing the prior experiences of inpatients; New standard procedures for blood preparation and transfusion were issued; and related clinical pathways were updated with supplementary measures. Results: After project implementation, the blood preparation rate declined significantly from 100% to 10.2%. The rate of effective transfusion rate rose from 23.8% to 76.2%. Conclusions: This project combined various medical professions to propose practical improvements that effectively access peer support. We recommend applying this model in all care units to ensure patient safety and lower medical costs while developing a more effective policy for blood transfusion.