A transfusion prescription template and other human factor interventions to improve balanced transfusion delivery in major haemorrhage due to trauma.

ObjectivesThe aim of this study is to improve practice in the management of major haemorrhage, particularly in red cell to plasma transfusion ratios. BackgroundA review of the management of major haemorrhage in trauma in Newcastle Hospitals Trust in 2012-2013 showed good mortality outcomes but found that red cell:plasma transfusion ratios could be improved. Human factors techniques transferable from industry and the military were identified, and a package of interventions was implemented, including an intensive multidisciplinary team training programme and a new major haemorrhage prescription template. Methods/materialsWe reviewed the management of all 243 adult trauma patients admitted with major haemorrhage to the Emergency Department in the Newcastle Hospitals Trust in the 4-year period from April 2012. We analysed clinical details, blood components transfused and patient outcomes and used Trauma Audit and Research Network data to correlate with injury severity and predicted survival. ResultsMean transfusion ratios of red cells to plasma improved from 15:1 and 16:1 in the first 2years to 11:1 in the 2years following implementation of the new measures. There was a statistically significant improvement in the delivery of a balanced transfusion, defined as a red cell:plasma ratio of <13:1 following the changes. ConclusionSimple changes to procedures, specifically implementation of a new major haemorrhage prescription template and multidisciplinary team training, have resulted in marked improvement in the ratio of red cells to plasma transfused to trauma patients with major haemorrhage or requiring emergency blood. The package of changes could be easily replicated in other health-care settings.