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Address *	Emergency Department, Maharajnakhonsrithamarat hospital, Nakhonsrithamarat Province , south of Thailand
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TITLE :   Improvement strategies timing for Blood transfusion: Output from trauma audit at  
MaharajNakhonSiThamarat Hospital
  PROBLEM UNDER STUDY :  Trauma Audit through a Peer Review Process at MaharajNakhonSiThammarat Hospital (from August to December, 2008) showed that all mortality cases (total 15 and 5.08 per cent of total mortally admitted during the period) were related to a delay of blood transfusion (10.34 per cent). The cause of the delay was due to there was no clear indication and level of urgency for the blood bank to provide blood and its components. Thus, cross-matching was prepared in the same way for those in need for emergency use and elective transfusion. The consequence caused the delay in resuscitation for the traumatic patients needed an immediate surgical intervention. As a result, blood and blood components could be administrated more than one hour after a request. To solve this delay problem, the indication for cross-matching and blood transfusion preparation were reviewed by surgeons, anaesthesists, traumatic nursing staff and blood bank personals.
OBJECTIVE : To decrease the delay time of blood and blood components administration.
RESULTS: After the new agreement, partially cross-matching could be done within 30 minutes, to match with  ABO and Rh D group within 20 minutes and uncross-matched pack red cell group O within 10 minutes. Blood transfusion could be administrated without any delay with this new agreement.
CONCLUSION:  The initial request depended on surgeons judgment. The new agreement allowed staff to request blood transfusion based on the severity of traumatic patients and this could prevent a delay problem.

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