Selective Type and Screen: The Lowest Hanging Cost Savings in the Initial Evaluation of Pediatric Trauma Patients
Maria F. McMahon, MSN, RN, PNP-PC/AC1; Heidi L. Almodovar, MSN, RN, PNP-AC2; David P. Mooney, MD, MPH1
1Boston Children's Hospital, Boston, MA; 2Boston Children's Hospital, St. Petersburg, FL
A type and screen (T&S) has historically been a part of the "standard trauma lab panel" in the Emergency Department (ED) during a pediatric trauma evaluation. A T&S consists of: ABO grouping, Rh screening and antibody screening, each of which carries a cost. To reduce costs associated with the ED evaluation of pediatric trauma patients, we sought to determine who ought to have a T&S. We extracted data from our trauma registry for all admitted injured patients who underwent an ED T&S, and those transfused packed red blood cells within 24 hours of admission over a 6 ½ year period. Data included patient injury diagnoses, procedures, disposition and trauma activation level. Of 7,496 trauma patients admitted, 1,696 (22.6%) underwent an ED T&S with a cost of $379,904. Of those, 42 patients (2.5%) received blood products within 24 hours of admission. Of them, 36 (85.7%) were a highest level activation, 4 (9.5%) were a lower level activation admitted from the ED to the ICU, and 2 (4.8%) were a lower level activation admitted from the ED to the OR for Orthopedic procedures. No lower level activation trauma patient admitted to the floor required blood product administration within 24 hours. Drawing a T&S for only the highest level trauma activations and for lower level trauma activations who either are admitted to the ICU or undergo a high transfusion risk procedure, saves an average of $49,280 dollars in costs annually, without delaying access to blood for those in need.
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