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Objective: To determine the normative rates of expiration and wastage for units of fresh frozen plasma (FFP) and platelets (PLTs) in hospital communities throughout the United States, and to examine hospital blood bank practices associated with more desirable (lower) rates., Design: In 3 separate studies, participants in the College of American Pathologists Q-Probes laboratory quality improvement program collected data retrospectively on the numbers of units of FFP and PLTs that expired (outdated) prior to being used and that were wasted due to mishandling. Participants also completed questionnaires describing their hospitals' and blood banks' laboratory and transfusion practices., Setting and Participants: One thousand six hundred thirty-nine public and private institutions, more than 80% of which were known to be located in the United States., Main Outcome Measures: Quality indicators of FFP and PLT utilization: the rates of expiration and wastage of units of FFP and PLTs., Results: Participants submitted data on 8 981 796 units of FFP and PLTs. In all 3 studies, aggregate combined FFP and PLT expiration rates ranged from 5.8% to 6.4% and aggregate combined FFP and PLT wastage rates ranged from 2.0% to 2.5%. Among the top-performing 10% of participants (90th percentile and above), FFP and PLT expiration rates were 0.6% or lower and FFP and PLT wastage rates were 0.5% or lower. Among the bottom-performing 10% of participants (10th percentile and below), expiration rates were 13.8% or higher and wastage rates were 6.8% or higher. We were unable to associate selected hospital characteristics or blood bank practices with lower rates of FFP and PLT utilization., Conclusions: The rates of FFP and PLT expiration and wastage vary greatly among hospitals in the United States. Hospital blood bank personnel are capable of achieving FFP and PLT expiration and wastage rates below 1%.

Context.-Critical laboratory values are values that may be indicative of life-threatening conditions requiring rapid clinical intervention. Designation of critical values by clinical laboratories is required by the Clinical Laboratory Improvement Amendments and regulatory agencies. The development of critical values often involves consultation with clinical services. Also, questions are frequently asked about how critical values compare between institutions. Objective.-To examine and compare critical value ranges for selected common critical value analytes. Additional specific questions addressed the source of these values, the inclusion of specific items on a critical values list, and the procedures for establishing such lists. Design.-A total of 163 clinical laboratories provided critical values for potassium, calcium, magnesium, thyroid-stimulating hormone, hemoglobin, platelet count, and activated partial thromboplastin time. Collected data were subjected to analysis for statistical variation. A questionnaire regarding demographic characteristics, institutional practices, and critical values management was also completed by participants. Results.-There was slight variation in pediatric and adult critical values used by the central 80% of study laboratories. Three areas of interest were noted: (1) 27% of laboratories allowed nonpractitioners to accept inpatient critical value reports, (2) there was nonconsensus regarding the handling of outpatient critical values during weekday versus evening/weekend hours, and (3) only 56% of respondents had a written critical values policy or procedure. Conclusions.-Pediatric and adult critical values for the selected analytes were consistent in a comparison between the 163 clinical laboratories. Several weaknesses in current critical values management were identified. A consensus critical values list that may be of value to other institutions was assembled. [ABSTRACT FROM AUTHOR]

The author discusses the use of clinical decision support systems (CDSS) in computerized physician order entry (CPOE) to improve plasma transfusion guidelines' compliance. He mentions that blood is primarily transfused as one of the fractionated components such as red blood cells, platelets or plasma. He adds that blood utilization and management are increasingly high profile for health system.