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. 2022 Dec 1;158(6):730-738.
doi: 10.1093/ajcp/aqac121.

Changes in Coagulation Testing During a National Shortage of Blue-Top Tubes

Hannah G Schuett  1 , Oksana Volod  2 , Anders H Berg  2 , Kyu Rhee  2 , Sam S Torbati  3 , Richard V Riggs  4 , David P Frishberg  2
Affiliations

Changes in Coagulation Testing During a National Shortage of Blue-Top Tubes

Hannah G Schuett et al. Am J Clin Pathol. .

Abstract

Objectives: Manufacturer recalls and altered supply chains during the coronavirus disease 2019 (COVID-19) pandemic caused a nationwide shortage of blue-top tubes (BTTs). Most non-point-of-care coagulation tests use these tubes, leaving laboratories and health care facilities in short supply. The Department of Pathology and Laboratory Medicine at Cedars-Sinai Medical Center implemented interventions to conserve supply without sacrificing patient safety.

Methods: In a retrospective quality improvement analysis, we examined coagulation testing and BTT utilization over the 3-month interval during which our interventions were applied. Our study assessed the interventions' effectiveness by evaluating changes in BTT utilization, coagulation testing volume, and patient impact.

Results: Average daily use (ADU) of BTT before and after the intervention were 476 and 403, respectively-a 15.2% reduction. Notably, the Emergency Department had a reduction in ADU of 43.3%. Average daily volumes of coagulation assays performed decreased from 949 to 783-a 17.5% reduction. No adverse events from the Pharmacy Department were identified during the study period.

Conclusions: Interventions resulting in significant reductions were in divisions with effective management and supervision. Success in navigating the BTT shortage stemmed from timely announcements, action, and effective communication. Our recommendations established more effective coagulation assay utilization, decreased overall BTT use, and prevented patients with coagulopathic disorders from experiencing adverse consequences.

Keywords: Blue-top tubes; COVID-19; Laboratory stewardship; Shortage.

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Figures

FIGURE 1
FIGURE 1
Blue-top tubes (BTTs) used. The vertical dashed line represents the date of intervention. A, Total during the study period and the 3 preceding years. B, Emergency Department.
FIGURE 1
FIGURE 1
Blue-top tubes (BTTs) used. The vertical dashed line represents the date of intervention. A, Total during the study period and the 3 preceding years. B, Emergency Department.
FIGURE 2
FIGURE 2
Core laboratory assays performed (7-day moving average). The vertical dashed line represents the date of intervention. A, Total. B, Prothrombin time. C, Activated partial thromboplastin time.
FIGURE 2
FIGURE 2
Core laboratory assays performed (7-day moving average). The vertical dashed line represents the date of intervention. A, Total. B, Prothrombin time. C, Activated partial thromboplastin time.
FIGURE 3
FIGURE 3
Special testing–performed assays (7-day moving average). The vertical dashed line represents the date of intervention.
FIGURE 4
FIGURE 4
Weekly point-of-care testing (POCT) performed 4 weeks before and after the intervention. A, i-STAT (Abbott Diagnostics) kaolin activated clotting time (ACTk). B, Hemostasis Management System (Medtronic) ACTk. C, CoaguChek (Roche Diagnostics) international normalized ratio.
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References

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