Abstract
Introduction:Somebleeding is an expected consequence of cardiac surgery. Excessive or uncontrolled bleeding is a complication requiring timely management andmayrequire blood transfusion/s. Turnaround times for standard laboratory tests (SLT's) is often too slow to guide treatment. Hence, blood products are often transfused before SLT results are available. Blood product transfusion is not without risk and is independently associated with increased risk for morbidity/mortality. Objectives: To improve diagnosis of haemostatic dysfunction and bleeding management, in July 2012 we commenced the implementation of a clinician driven POCT service using rotationalthromboelastometry (ROTEM) and platelet function (Multiplate) at The Prince Charles Hospital. Methods: A multidisciplinary, multimodal approach was taken and involved appointment of a project lead, identifying stakeholders, developing a project plan, educating POCT operators/ interpreters, developing quality control infrastructure and monitoring/analysing outcomes. Results: A comparison of post POCT implementation data with historical controls demonstrated a decrease in percentage patients receiving RBC's (p = 2.965e-08), FFP (p less than 2.2e-16) and platelets (p less than 2.2e-16). Units per patient was reduced for RBC (p = 1.8413e-09), FFP (p = 5.4988e-25) and platelets (p = 8.5073e-27). A significant decrease was seen in reexploration rate for bleeding (p = 0.0509) and median hospital LOS (p = 9.3657e-09). Conclusions: Implementation of our POCT service reduced percentage of patients receiving blood products as well as quantity of products transfused. Timely results allowed clinicians to treat coagulopathy, with only those products required to resolve haemostatic dysfunction. Key to this success is a dedicated project lead and a multidisciplinary, multimodal approach involving all stakeholders.
