Impact of Process Improvement Interventions on Emergency Blood Component Utilization: A Before–After Clinical Audit from South India

Background: Emergency release of blood, often involving uncrossmatched O negative or group-compatible packed red blood cells (PRBCs), is vital for trauma and non-trauma cases where immediate transfusion is needed.Optimal utilization of blood components during emergencies improves patient outcomes.The study assessed the impact of a structured quality improvement program on emergency blood release (EBR) practices, including indications, documentation, turnaround time (TAT), appropriateness, and blood component use.Study design and methods: A two-phase clinical audit was conducted at a tertiary care center in South India after audit committee clearance.Phase I retrospectively analyzed emergency release forms (ERFs) from January 2019 to December 2023 (5 years).A revised ERF with additional parameters was introduced in January 2024, followed by phase II-prospective analysis for 12 months post-training of staff and clinical users.Results: Phase I documented 221 emergency release requests (1.06%), compared with 101 requests in phase II (2.2 %).Medical indications constituted the majority in both phases, increasing from 64.7% in phase I to 88.1% in phase II.Across both phases, upper gastrointestinal (UGI) bleeding remained the most common indication (49%), followed by road traffic accidents (RTAs) (8%), with the emergency room (ER) being the most frequent location of request.In phase II, TAT showed a median of 4 minutes, and documentation of indications and transfusion triggers improved significantly.Bleeding was the most common trigger (66%).Massive transfusion rates decreased (37.1-10.8%),alongside reduced use of fresh frozen plasma (FFP), platelets, and cryoprecipitate (p < 0.05).No cases of alloimmunization or adverse reactions were noted during the study.Discussion: Standardized documentation, well-defined transfusion triggers, and effective interdepartmental coordination are essential to ensure the judicious use of emergency blood components.Mandatory and timely blood grouping and typing for high-risk patients can reduce unnecessary O negative utilization and enhance transfusion safety.