Improving Massive Transfusion Protocol Activation Times Through ABC Score Implementation, Multidisciplinary Education, and Friendly Competition 

General Information

Institution Name: Huntington Memorial Hospital 

Author Name and Title: Joyce Roque BSN, RN, TCRN 

Name of Case Study: Improving Massive Transfusion Protocol Activation Times Through ABC Score Implementation, Multidisciplinary Education, and Friendly Competition 

Identification of Local Problem

In November 2024, our Trauma Services team implemented the Assessment for Blood Consumption (ABC) Score, per ACS recommendations, to establish objective criteria for activating the Massive Transfusion Protocol (MTP) after uncovering inconsistencies in activation times. 

Context of the QI Activity

The QI activity was a comprehensive education initiative, which targeted attending trauma surgeons, surgical residents, anesthesiologists, and all ED, OR, PACU, CCU, and surgical nursing staff to ensure team-wide familiarity and confidence in applying the ABC Score. Further, while not a formally measurable or tangible intervention, we suspect that sharing individual activation times among the trauma surgeons—and sparking some friendly competition—played a meaningful role in driving these improvements.

What were the interventions?

• We revised our Clinical Practice Guideline, specifying that MTP activation should occur once the trauma patient meets at least two of the four ABC Score criteria. Trauma surgeons were informed that their MTP activation times would be tracked monthly, measured from criteria met to activation order. The Blood Bank Manager provided monthly reports of all trauma MTP activations for data analysis and feedback. We shared these numbers monthly with our attending surgeon team so they could view their individual performance, as well as their peers.
• To proactively support increased activations, we prepared ED/OR/PACU/CCU/surgical nursing staff through targeted education on blood administration sequencing, whole blood utilization research, and hands-on Belmont Rapid Infuser training. Additionally, we added an education focus on our anesthesiologist team in the OR as they are primarily managing MTP administration, unlike in the ED where the administration is nurse driven.
• We also developed practical tools including MTP “badge buddies,” laminated unit signage, and integrated MTP/Belmont/ABC Score education into our New Grad RN and New Hire RN Trauma Orientation Day. To further ensure timely responses, the Blood Bank acquired two additional MTP coolers.

Cost and Funding Resources

• Our Philanthropy department utilized donor funds to support trauma nursing education days.
• Our Blood Bank department invested $24,852 to purchase two additional BioFridge coolers to ensure expeditious response times in anticipation of more frequent activations

Overall Results and Analysis

A one-year audit assessed the impact of these interventions. From May–October 2024 (pre-revision), the average time from meeting ≥2 ABC criteria to MTP activation order was 24 minutes. Over the six-month survey period post-revision (November 2024–April 2025), activation order times decreased by 81.7%, with the trauma surgeon group achieving an average activation time of 4.4 minutes. 

Limitations

• There did not seem to be a correlation with faster MTP activation times having decreased mortality or length of stay which was one of our hopes with this initiative.
• One surgeon’s data had to be removed as she rarely takes call and only had data for previous six months, but not the six months following.

Lessons Learned

Implementing the ABC Score alongside focused multidisciplinary education, process improvements, and a sprinkle of surgeon-friendly competition resulted in a significant, sustained reduction in MTP activation times. These findings highlight the value of structured guidelines, transparent data sharing, and a little healthy team motivation in transforming culture and optimizing trauma resuscitation practices.