Reducing Overuse of 3-Day Repeat Type and Screen Testing across an 11-Hospital Safety Net System

Abstract

Background: According to the American Association of Blood Banks, a Type and Screen (T&S) is valid for up to three calendar days. Beyond a limited number of clinical indications such as a transfusion reaction, repeat T&S testing within 3 days is not warranted. Inappropriate repeat T&S testing is a costly medical waste and can lead to patient harm.

Objective: To reduce inappropriate duplicate T&S testing across a large, multihospital setting.

Setting: The largest urban safety net health system in the USA, with 11 acute care hospitals.

Interventions: Our first intervention involved adding the time elapsed since the last T&S order into the order and the process instructions that described when a T&S was indicated. The second intervention was a best practice advisory that triggered when T&S was ordered before the expiration of an active T&S.

Main measures: The primary outcome measure was the number of duplicate inpatient T&S per 1000 patient days.

Key results: Across all hospitals, the weekly average rate of duplicate T&S ordering decreased from 8.42 to 7.37 per 1000 patient days (12.5% reduction, p < 0.001) after the first intervention and to 4.32 per 1000 patient days (48.7% reduction, p < 0.001) after the second intervention. Using linear regression to compare pre-intervention to post-intervention 1, the level difference was - 2.46 (9.17 to 6.70, p < 0.001) and slope difference was 0.0001 (0.0282 to 0.0283, p = 1). For post-intervention 1 to post-intervention 2, the level difference was - 3.49 (8.06 to 4.58, p < 0.001) and slope difference was - 0.0428 (0.0283 to - 0.0145, p < 0.05).

Conclusions: Our intervention successfully reduced duplicate T&S testing using a two-pronged electronic health record intervention. The success of this low effort intervention across a diverse health system provides a framework for similar interventions in various clinical settings.

Keywords: medical waste; overuse; patient safety; quality improvement; type and screen.

Figure 1

a New process instructions with advisory statement within the Type and Screen order. b Duplicate Type and Screen Best Practice Advisory.

Figure 2

Interrupted time series regression comparing the weekly average rate of duplicate T&S preintervention to postintervention 1 and 2.