M. W. Cripps1, C. T. Minshall1, B. Williams1, A. Eastman1, R. Sarode1 1University Of Texas Southwestern Medical Center,Burn/Trauma/Critical Care,Dallas, TX, USA
Introduction: Rotational Thromboelastometry (ROTEM) is a viscoelastic analyzer that identifies patient-specific coagulopathy thereby providing a patient directed transfusion strategy. In order to be effective, patients in hemorrhagic shock with associated coagulopathy need an expeditious return of ROTEM results as rapid correction of coagulopathy significantly improves patient outcomes. Although often used at bedside, ROTEM can be used to guide transfusions from a centrally located lab while results are viewed in real time from remote locations. Benefits include hospital wide availability and multi-disciplinary use. However, potential pitfalls in using a centrally located ROTEM include increased sample delivery and processing times. We performed a time efficiency study to identify work elements that could be streamlined to determine if we could improve the speed at which viscoelastic results are returned from a centrally located viscoelastic analyzer (ROTEM) in trauma patients.
Methods: A time efficiency study to evaluate work elements required in central lab ROTEM analyses on trauma patients was performed. Elements included time from sample collection to lab arrival and time to initial display on remote viewing monitor. These were measured for all ROTEM studies during January 2015 to calculate standard time per element and normal time to view results. We then implemented protocol changes to shorten the duration of each work element and prospectively measured them over the subsequent 3 months.
Results: 33 consecutive ROTEM studies performed during a 1 month period determined standard time per element and the normal time per study. The median time from sample collection to lab arrival was 11 min [8, 18]. Time from lab arrival to remote display of results was 10 min [6, 12.5]. The normal time per study was 22.9 min [18.7, 28]. 196 consecutive ROTEM studies were performed after protocol changes and there was no difference in the time from sample drawn to lab arrival, 9min [6.7, 13] p=0.11, but time from lab arrival to initial display was significantly reduced to 5.6 min [3, 7.8], p<0.0001. Modifications in work-flow resulted in a reduction in normal time per study to 14.8 min [10.7, 20.1]; p<0.0001.
Conclusion: Using a centrally located ROTEM to guide trauma transfusions requires optimized processes to obtain rapid return of results. We were able to modify performance and effectively shorten the standard time per work element resulting in a significant reduction in the normal time to view results. This study validates that a centrally located ROTEM can rapidly return results for any hospitalized patient with hemorrhagic shock.
