Blood Product Shortage Crisis Simulation Exercise: A Pilot Study in Contingency, Emergency Preparedness Planning, and Management of Critical Patient Care Deliverables
Authors: Kanakis Constantine E , O'Shaughnessy Laura , Ramsey Glenn , Lindholm Paul , Nieb Jacob , Carabini Louanne 
Published: December 2024

The Transfusion Service at Northwestern Memorial Hospital (NMH) includes the clinical support of a Level I Trauma Center, 12,000 annual deliveries, and a robust catalog of nationally ranked medical and surgical specialty care with an adjacent Level I Pediatric Trauma Center, with active neonatal and pediatric intensive care units and a large population of patients with sickle-cell, thalassemia, and other hematologic and stem cell transplant needs. Combined, the services perform over 1,000 stem cell and organ transplants per year. In 2023, more than 50,000 products were prepared and transfused in support of these diverse needs, including solid organ transplant, orthopedics, hematology/oncology, labor & delivery, neonatal intensive care and more. Blood product usage continues to rise. Concurrently, the levels of in-house inventory (as supplied by major regional blood suppliers) are challenged by intermittent supply shortages. The NMH Blood Bank and Medical Ethics Program has developed contingency protocols to address the imbalance between this supply and demand to use as a framework to provide safe, high-quality patient care. An interdisciplinary session was held with representatives of the NMH Blood Transfusion Committee, including members from blood bank management, laboratory operations, and physicians representing both clinical and non-clinical roles. After discussion and review of the drafted policies regarding blood product shortages and massive hemorrhage protocols, a tabletop simulation (TTS) exercise was conducted with five realistic case scenarios based on actual clinical events at NMH to test the protocols' strength. An immediate debrief of the exercise with all participants was well received, and a subsequent survey demonstrated an overall favorable response to the exercise. Of the surveyed interdisciplinary participants, the exercise's overall average rating was scored 4.92 out of 5 for confidence, experience, and realism. Participants noted hesitancies in the Incident Command process, level of mixed specialty representation, and active participation. Net promoter scores (out of 100) were reported for how the exercise prepared participants (50), clarified the incident command process (41), and the impact on patient outcomes (83). Qualitative feedback focused mostly on increasing interdisciplinary representation to include administration and protocol officers, more advanced and dynamic drills, and more varied scenarios including shortages other than red cell products. Overall, this blood shortage tabletop simulation exercise was a dynamic and successful application of the drafted policies regarding blood bank contingency and emergency preparedness. Evidence-based models were used to form the survey, and the collected data show a positive impact on clinical leadership in a potential blood product shortage crisis. Utilizing these models, we hope to extrapolate this performance into three effective arms. First, the feedback from the surveys will help bolster the standing operating procedures on both shortage contingency management and applications to massive hemorrhage, while maintaining high quality standards. Second, this exercise will act as a nidus for future shortage drills and to test new challenges to the secure and ethical delivery of blood products. Finally, NMH represents one of several large academic and community hospital sites across the greater Chicagoland area. As a certified and accredited state and national leader in Patient Blood Management, partnership with other local Level I Trauma Centers and community blood banks may dynamically improve patient care with respect to blood utilization and preserve delivery in a city that imports more blood product that it exports.