Collaboration between pediatric, plastics teams behind new blood transfusion protocol

When it comes to complex pediatric cases, there’s rarely such thing as too many cooks in the kitchen.

By its very nature, pediatric plastic surgery is collaborative. Craniofacial surgeons like Jessica Ching, M.D., regularly overlap with other disciplines in order to provide comprehensive care that addresses each aspect of the patient.

Jessica Ching sits at her desk with a 3-D printed skull in front of her.
Jessica Ching, MD, operates on pediatric patients, specializing in cranial and facial reconstruction procedures.

In many cases, collaborative research projects spur new guidelines for clinical practice that are implemented across the system—like a novel blood management protocol Ching developed in conjunction with pediatric neurosurgery and anesthesia.

“Our goal was to not only reduce transfusion and blood product usage for these cases, but to make sure we had a means of doing so safely,” said Ching, Surgical Director of the University of Florida Craniofacial Center. “Part of that process required making sure that team members from anesthesia, pediatric neurosurgery, pediatric intensive care unit providers, and the blood bank could agree on creating something that prioritized safety and evidence-based practice.”

Previously, the hospital’s transfusion rate was close to 100%, Ching said. Now, it’s down to 20%, a change that has been sustained for the past two years. The national average for transfusion remains at 95%.

“It’s a real proof of the success that comes from collaboration among many different disciplines that chose not to operate in their individual silos, but to work together to improve patient safety,” she said.

Blood transfusion generally carries a risk of donor exposure to disease, or patients developing antibodies to future blood products, rendering them unable to receive blood in the future. It’s also associated with increase length of stay in the hospital and contributes to poor outcomes when compared to patients who did not require transfusions.

Part of this has to do with the physiology of the blood, Ching explained.

“The red blood cells in the blood sourced from the blood bank are not 100% functional when given to the patient,” she said. “Despite proper storage and maintenance, the blood cells are in a state of shock when they’re put on the shelf in the blood bank and experience further natural attrition over time. Thus, only a certain percent of those blood cells can function immediately.”

Ching’s protocol outlines a means to save any blood lost by the patient during surgery by reprocessing it and transfusing it.

“It’s their own blood that we provide back to them, which is unique for this procedure in this patient population as it requires special equipment for smaller pediatric patients and corresponding volume,” Ching said.

Using specialized equipment obtained by Dr. Bruce Spiess, Ching and her team can increase opportunities for patients to receive their body’s blood, where a much higher percentage of the red blood cells are immediately functioning upon transfusion.

Identifying an opportunity to improve something as straightforward as blood transfusion protocol has far-reaching effects. Quality improvement can be as simple as identifying an issue with patient care that you see and think: I could do that better, and optimizing it, Ching said.

“It’s a very natural part of the innovation side of medicine and surgery,” Ching said. “In a way, it’s something people do all the time without always realizing it.”