Improving Massive Transfusion Protocol Response in the Rural Level III Trauma Center Setting.

BACKGROUND

Massive transfusion protocol (MTP) activations at rural Level III trauma centers often face blood delivery delays, limited support, and product waste. While MTPs are well described in higher-level centers, their effectiveness and staff perceptions in rural Level III settings are unclear. Process breakdowns at one such center, including staffing gaps, delivery delays, and product waste, prompted implementation of a targeted MTP response system.

OBJECTIVE

This project aims to evaluate the effectiveness of an MTP activation response system in a rural Level III trauma center setting.

METHODS

This quality improvement project, using a descriptive design with qualitative methods, was conducted at two rural Midwestern, US Level III trauma centers within the same health system from August 1, 2023, to February 1, 2024. The population included all interdisciplinary team members participating in MTP activations. The project's revised MTP activation response system featured centralized dispatcher notifications, new modes of communication, multidisciplinary education, and clarification of team roles and processes. After each activation, project participants received a secure, online, anonymous questionnaire assessing perceived system effectiveness, resource delivery, communication, and documentation. Responses were analyzed using descriptive statistics for quantitative data and narrative analysis for open-ended responses to identify thematic outcomes.

RESULTS

A total of N = 35 team members responded across eight MTP activations using the revised response system, including 16 (46%) nurses, 7 (20%) blood bank staff, 5 (14%) pharmacists, 5 (14%) administrative supervisors, and 2 (6%) physicians. Key barriers included inaccurate paging (50%), communication challenges (62.5%), and rapid infuser issues (50%). Appropriate calcium administration occurred in 87.5% of cases; compliance with documentation was high, with 89% noting unit documentation and 83% order confirmation.

CONCLUSION

Implementing a structured multidisciplinary MTP response system in rural Level III trauma centers improved resource delivery, team coordination, and documentation, although communication and workflow challenges persisted.