LAUSR

Introduction Perioperative coagulopathy during cardiac surgery is associated with increased morbidity, mortality, and cost.1 Point of care thromboelastography (TEG) has been shown to decrease unjustified non-RBC transfusion during cardiac surgery.2 Herein we describe an intervention that increased guideline adherence. Methods In this single center quality improvement study, we prospectively collected functional and static coagulation data on all consecutive cardiac surgeries performed between May 2019 and October 2019. After 11 weeks, we introduced pre-labeled syringe bundles in an effort to increase compliance in ordering baseline (BT) and post-protamine (PPT) TEGs. Results From May 2019 to October 2019, we collected data on 166 cardiac surgical cases. Prior to our intervention we had collected data for 84 cases, at which time, ordering compliance was 55% and 61% for BT and PPT, respectively. Following the introduction of pre-labeled syringe bundles, compliance improved to 85% and 95% for BT and PPT, respectively. These results are displayed in Figure 1. Discussion The introduction of pre-labeled syringe bundles improved ordering compliance by approximately 30% for both BT and PPT. Choice architecture has long been utilized in implementation science as a way to improve guideline adherence. Additional work is needed to describe the impact of our intervention on the absolute reduction in blood product utilization during cardiac surgery.