Potential Process Improvements Research Articles

Life Cycle Assessment of Bioethanol Produced from Banana Peduncle

Abstract Biofuel production has been promoted in part to reduce dependency on fossil fuels in transportation due to fewer environmental emissions. Feedstocks for biofuels include agricultural waste and non-edible crops, suggesting that large amounts of waste can be used to produce biofuels such as bioethanol, which is currently being blended with gasoline in the Philippines as transportation fuel. However, shifting from non-renewable fuels to bioethanol and other biofuels as the dominant transportation fuel must consider aspects other than fuel usage. The objectives of this study are to perform cradle-to-grave life cycle analysis on bioethanol produced from banana peduncle and determine the contributions of each stage in the life cycle to different environmental impacts and compare the results with those of other transport fuels. The contributions of each stage in the life cycle of bioethanol are modelled in openLCA software with the ReCiPe impact assessment method. It was identified that electricity use in simultaneous saccharification and fermentation, and sulfuric acid consumption are the main contributors to the different environmental impacts. Comparison of the results of banana peduncle bioethanol production stage to those of the first-generation bioethanol production showed that most of the emissions were lower except for those pertaining to freshwater ecotoxicity, human toxicity, marine ecotoxicity, and metal depletion. Comparing fuel use, environmental impacts of conventional gasoline were slightly lower than those of a 10% mix with bioethanol. But impacts of the 85% mix with bioethanol in climate change and marine eutrophication are higher by 29% and 37%, respectively, than those of conventional gasoline. Overall, increasing the ethanol concentration would reduce the emissions during fuel usage but impacts of production will increase. Potential process improvements for environmental performance of bioethanol from banana peduncle are in the pre-treatment methods and fermentation set-up in bioethanol production, use of renewable power, and ethanol blending concentrations with gasoline.

Quality of hydroxychloroquine retinopathy screening at a Canadian teaching hospital.

To assess the quality of hydroxychloroquine (HCQ)-induced retinopathy screening at a Canadian tertiary center, we concentrate on risk factor documentation within the electronic health record, in accordance with the 2016 AAO guidelines. We performed a retrospective quality assessment study based on chart review of patients who underwent screening for HCQ-induced retinopathy at the Centre Hospitalier de l'Université de Montréal (CHUM) from 2016 to 2019. We evaluated four key risk factors for HCQ-induced retinopathy: daily dose, duration of use, renal disease, and tamoxifen use, using a three-tier grading system (ideal, adequate, inadequate) for documentation assessment. Pareto and root cause analyses were conducted to identify potential improvement solutions. Documentation quality varied in our study: daily dosage was 33% ideal, 31% appropriate, and 36% inappropriate. Duration of use documentation was 75% ideal, 2% adequate, and 24% inadequate. Renal disease documentation was only 6% ideal, with 62% adequate and 32% of charts lacking any past medical history. Among women's charts, tamoxifen use wasn't documented at all, with 65% adequately documenting medication lists. Pareto analysis indicated that improving renal disease and tamoxifen documentation could reduce 64% of non-ideal records, and enhancing daily dose documentation could decrease this by up to 90%. Accurate documentation of key risk factors is critical for HCQ-induced retinopathy screening, impacting both exam initiation and frequency. Our study identifies potential improvements in the screening process at the hospital, referring physician, and ophthalmologist levels. Implementing integrated pathways could enhance patient experience and screening effectiveness.

Thermoeconomic analysis of sCO2 power cycles

AbstractThe second‐law analysis evaluates the irreversibilities of a process. Systematic study of the relationship between thermodynamic efficiency and process modifications enhances process synthesis. The Allam cycle is an oxy‐fuel combustion cycle with nearly complete carbon capture that offers greater efficiency than current electricity generating systems. This study applies lost work analysis to the original Allam cycle and three modifications to obtain the distribution of irreversibilities and the effects of different configurations among potential process improvements for more sustainable power generation. The major inefficiencies are from the combustors and heat exchangers. We also examine the economic profitability of the alternatives. The largest equipment costs are for the turbines, compressors, and recuperators. We find that improving efficiency leads to less economic return; a configuration with partial compression has the highest efficiency, while the original Allam cycle has the highest profitability. We discuss how to resolve this apparent conflict between sustainability and profitability.

PH-switchable W/O drag reducer emulsions based on dynamic covalent stabilizers for efficient stabilization and rapid dissolution of drag reducers

As the global emphasis on shale oil extraction grows, there is a rising demand for slickwater fracturing fluids for reservoir stimulation. Polyacrylamide drag reducers plays a crucial role in slickwater and are available in two primary forms: powder and emulsion. Powder-based drag reducers suitable for long-term transportation and storage, but increasing their dissolution rate remains a challenge. While emulsion-based drag reducers are valued for the efficient dissolution facilitated by hydrophilic phase-inversion surfactants, the incorporation of the surfactants compromise the stability of W/O emulsions. In this work, an imine-functionalized pH-switchable stabilizer was synthesized, and the W/O emulsion constructed with the stabilizer underwent demulsification at a pH of 4.9. The pH-switchable emulsion system was optimized, and inverse emulsion polymerization using the stable monomer emulsion was performed for preparing pH-switchable drag reducer emulsions. The drag reducer emulsion features remarkable resistance to instability even after 30 days of storage owing to the absence of phase-inversion surfactants. The imine bond on the stabilizer was cleaved in acid solution, allowing the switchable drag reducer emulsion to be rapidly released and dissolved in water at pH 2.75, boasting an impressive dissolution rate of only 150 s. Furthermore, the pH-switchable drag reducer emulsion demonstrated effective drag-reduction performance, achieving a drag-reduction rate as 73 % at a concentration of 0.06 wt%. The pH-switchable drag reducer emulsion effectively resolves the conflict between rapid dissolution and efficient stabilization of drag reducer, thus offering potential improvements in the formulation process of slickwater and the efficiency of shale oil development.

Current problems and prospects of improving anti–crisis management

An important part of effective crisis management, along with early diagnosis, crisis prevention and bringing the organization out of a crisis state, is the use of risk factors for subsequent development, that is, the improvement of crisis management. Competent crisis management takes into account the characteristics of past crises, thanks to which strategies and approaches to management are gradually improved. It is important to continually analyze crisis management issues to help identify areas for potential process improvement. This is especially true for organizations seeking long–term sustainability and success in complex and constantly changing market conditions.The subject of research in the article is the problems and prospects for improving crisis management. The study examines current problems and challenges faced by modern crisis management, and highlights prospects for its improvement. The author analyzed the issues and factors influencing the effectiveness of crisis management, systematized current problems of crisis management, noted prospects for its development, most of which are aimed at integrating new technologies, transition to flexible mechanisms for responding to changes in the external environment, in–depth understanding of global risks and special attention to proactive measures to prevent crises.

Digitisation of Rail Transport: The Application that Delivers Faster and More Efficient Services

Abstract The article analyses the use of modern technologies in rail freight transport with a specific focus on the process of transferring information from transport documents through automatic identification technology. The main transport document in this context is the consignment note, where automatic identification is required. The automatic identification technologies investigated are RFID/NFC and QR code, with the analysis suggesting that QR code is more accessible and convenient in the current railway environment. However, in practice, limitations have emerged regarding the capacity of the stored information and the readability of the QR code data. It concludes that the use of modern technologies in rail freight transport brings new opportunities and increases the efficiency of information transfer associated with transport documents. Despite the advantages of QR code technology, limitations have been identified, in particular in terms of capacity and readability. The results also show that users with access to modern technologies, such as internet-enabled mobile phones or computers with internet access, are able to handle this technology efficiently, suggesting potential process improvements in rail freight transport. Overall, the paper highlights the importance of integrated technology solutions within this sectoral area and suggests that technological advances are opening up new opportunities for more efficient management and monitoring of rail transport processes.

Modeling of bioprocess pre-stages for optimization of perfusion profiles and increased process understanding.

Improving bioprocess efficiency is important to reduce the current costs of biologics on the market, bring them faster to the market, and to improve the environmental footprint. The process intensification efforts were historically focused on the main stage, while intensification of pre-stages has started to gain attention only in the past decade. Performing bioprocess pre-stages in the perfusion mode is one of the most efficient options to achieve higher viable cell densities over traditional batch methods. While the perfusion-mode operation allows to reach higher viable cell densities, it also consumes large amount of medium, making it cost-intensive. The change of perfusion rate during a process (perfusion profile) determines how much medium is consumed, thereby running a process in optimal conditions is key to reduce medium consumption. However, the selection of the perfusion profile is often made empirically, without full understanding of bioprocess dynamics. This fact is hindering potential process improvements and means for cost reduction. In this study, we propose a process modeling approach to identify the optimal perfusion profile during bioprocess pre-stages. The developed process model was used internally during process development. We could reduce perfused medium volume by 25%-45% (project-dependent), while keeping the difference in the final cell within 5%-10% compared to the original settings. Additionally, the model helps to reduce the experimental workload by 30%-70% and to predict an optimal perfusion profile when process conditions need to be changed (e.g., higher seeding density, change of operating mode from batch to perfusion, etc.). This study demonstrates the potential of process modeling as a powerful tool for optimizing bioprocess pre-stages and thereby guiding process development, improving overall bioprocess efficiency, and reducing operational costs, while strongly reducing the need for wet-lab experiments.

Spatio-Temporal Assessment of Heavy-Duty Truck Incident and Inspection Data

Vehicular incidents, especially those involving tractor trailers, are increasing in number every year. These events are extremely costly for fleets, in terms of damage or loss of property, loss of efficiency, and certainly in terms of loss of life. Although the U.S. Department of Transportation (DOT) is responsible for performing inspections, and fleet managers are encouraged to maintain their fleet and participate in regular inspections, it is uncertain whether these inspections are occurring at a frequency that is necessary to prevent incidents. The Federal Motor Carrier Safety Administration (FMCSA) of the DOT manages and maintains the Motor Carrier Management Information System (MCMIS) dataset, which contains all incident and inspection data regarding commercial vehicles in the U.S. The purpose of this preliminary analysis was to explore the MCMIS dataset through spatiotemporal analyses, to uncover findings that may hint at potential improvements in the DOT inspection process and highlight location-specific trends in the dataset. These analyses are novel, as previous research using the MCMIS dataset only examined the data at the state or county level, not at a national scale. The results from the analyses pinpointed specific major metropolitan areas, namely Harris County (Houston), Texas, and three of the New York boroughs (Kings, Queens, and the Bronx), which were found to have increasing incident rates during the study period (2016–2020). An overview of potential causal factors contributing to this increase are provided as well as an overview of the inspection process, and suggestions for improvement relative to the highlighted locations in Texas and New York are also provided. Ultimately, it is suggested that the incorporation of advanced technology and automation may prove beneficial in reducing the occurrence of events that lead to incidents and may also help in the inspection process.

Survey on the current leachate treatments of public municipal solid waste landfills and the potential impact of per- and polyfluorinatedalkyl substances in the Eastern and Northwestern United States

ABSTRACT Leachate from landfills can be a significant challenge to manage and treat due to conventional contaminants. The addition of emerging contaminants such as per- and polyfluorinatedalkyl substances (PFASs) makes treatment even more complex. PFASs enter landfills through consumer waste and have been detected in landfill leachates at varying concentrations. The design and decision-making on leachate treatment require essential information since it depends on local factors, e.g. climate, proximity to wastewater treatment plants, and waste type. This study conducted a survey on actively operated public municipal solid waste (MSW) landfills in the Eastern and Northwestern regions of the US to understand the current leachate treatment practices and views from public MSW landfill managers on PFAS treatment. The survey aims to explore the possible adaptations from the industry to the pending regulatory guidelines for the potential PFASs treatment. Results show the majority of the landfills are currently using off-site disposal (72% of the responses), followed by complete onsite treatment (18% of the responses) and pre-treatment onsite and off-site disposal methods (10% of the responses). The factors that guided the selection of treatment methods included climate, economics, and future regulations. Evaporation and recirculation were the most prevalent onsite treatment technologies for public landfills, which reduced the leachate quantity for treatment. The public landfills expressed awareness of the potential impact of PFASs on the changes in leachate treatment. The current state-level regulation, potential federal PFAS regulation, and treatment costs are raising awareness of the onsite treatment for PFASs. The results of this study will benefit the improvement of PFAS awareness and provide critical information that will directly affect the leachate treatment process for PFASs. Implications: This study presents a survey on the current leachate treatment process in the public municipal solid waste landfills in the eastern and northwestern U.S. and their potential process improvement on the impact of PFASs. This study is relevant to the topic of the JA&WMA because the research falls directly within the scope of this journal, and it documents the leachate treatment of landfills, and the results of this study will immediately contribute to our understanding of the waste treatment, benefiting the improvement of PFASs awareness, and providing critical information that will directly affect the leachate treatment process.

Value in psoriasis (IRIS) trial: implementing value-based healthcare in psoriasis management – a 1-year prospective clinical study to evaluate feasibility and value creation

IntroductionCurrently, the healthcare sector is under tremendous financial pressure, and many acknowledge that a dramatic shift is required as the current system is not sustainable. Furthermore, the quality of care...

Development of an experienced quality measure for clients, informal and formal caregivers in home care in the Netherlands: A participatory action research

To optimise home care provision and to identify potential improvements in the care process, it is important to gain insight into the care experiences that influence care quality. The aim was to develop a qualitative experienced quality measure for home care in The Netherlands, facilitating conversations between clients and caregivers in generating possible points of improvement for the primary care process. A participatory action research design to develop the measure following three iterative cycles, using various data sources in evaluating requirements related to the goal, feasibility in care setting, and usability in the care process. The final design comprises an instruction meeting for district nurses and a structured approach to evaluate experienced quality with clients, informal caregivers, and formal caregivers. The measure encompasses cards to visually support communicating on experienced quality themes (e.g., personal needs and expectations), sub-themes (e.g., preferred way of communicating needs), exemplary questions, and a reporting sheet. The first evaluation gave indications of the measure results in formulating concrete points of improvement for the primary care process. This study indicates that the developed experienced quality measure seems promising relating to requirements for its goal, feasibility in the care setting, and usability in the care process. More insight is needed if and how improvements are communicated, documented, and followed-up in practice. In the next step, the measure should be extensively tested and evaluated in a more diverse sample (e.g., clients with dementia) for measuring experienced quality and reflecting on its outcomes.

Use of value stream mapping to improve the medication synchronization process

BackgroundLean methodology, specifically value stream mapping, can be used to identify and reduce inefficiencies in the medication synchronization process. ObjectivesThe objectives of this study were to (1) evaluate potential medication synchronization process improvements to reduce nonvalue-added actions, (2) assess fidelity to the medication synchronization core components, and (3) identify the best process for medication synchronization for an independent community pharmacy with multiple locations. MethodsThis study used an observational, cross-sectional design. A value stream map was created to provide a detailed illustration of each step in the medication synchronization process. Time for each step of the medication synchronization process was observed on site on different days and times as well as the time required to process, package, and verify prescription medications. These steps were conducted before interventions were made to the process and after to compare the difference. The organizational readiness for change tool was administered to employees of the independent pharmacy before interventions to determine their perspective of the medication synchronization process and assess their readiness for change. ResultsOwing to various interventions made to the medication synchronization process, 2 steps in the process were eliminated. This resulted in a decrease in adherence packaging time workflow by 69.4%. Staff (n = 9) rated the medication synchronization process on 4 components: acceptability of the current process (13.8 ± 3.6), intervention appropriateness (13.7 ± 3.7), feasibility of a new medication synchronization process (17.1 ± 2.3), and organizational level of support (21.8 ± 4.1). ConclusionValue stream mapping proved to be a valuable tool in identifying inefficiencies in the medication synchronization process and reducing nonvalue-added waste. The result was a decrease in time required for adherence packaging workflow and a more standardized medication synchronization process across multiple independent pharmacy locations. This more standardized process can play a key role in improving the continuity of patient care, increasing medication adherence, and in turn decreasing the number of hospital admissions.

Chemotherapy order second check and error discovery rates by pharmacists and technicians

BackgroundThe American Society of Health-System Pharmacists suggests that pharmacy practice models allow pharmacists to be readily available as organizational leaders. This project aimed to identify potential process improvements to increase pharmacist availability to perform more clinical activities. ObjectiveWe evaluated the effectiveness of pharmacy technicians performing chemotherapy second checks at an outpatient infusion clinic. Practice descriptionIntermountain Medical Center is a Level 1 Trauma Center. The infusion clinic treats a variety of oncology indications, with solid organ tumors being most prevalent. At Intermountain Healthcare, a second pharmacist reverifies all chemotherapy orders for accuracy of drug, dose, preparation, and administration instructions. Practice innovationPharmacy technicians are in a unique position to assist with chemotherapy second checks because they are already knowledgeable in compounding and reviewing chemotherapy. This would be particularly useful in rural settings where staffing is sparse. Evaluation methodsThis was a single-center prospective analysis of chemotherapy second-check processes at an outpatient infusion clinic. Once chemotherapy orders were sent to the infusion clinic, first and second checks were completed to verify the correct patient, medication(s), dose calculations, diluents, administration rates, volumes, and other instructions. The chemotherapy first checks were completed by a pharmacist. The second checks were completed by a second pharmacist and a chemotherapy-trained certified pharmacy technician. The second checks by the pharmacist and technician were compared to determine if they were in agreement regarding error identification. Any disagreements found between the 2 second checks or between the first check and either of the second checks were discussed before compounding. We evaluated whether a chemotherapy-trained pharmacy technician could identify the same errors as a pharmacist. ResultsThe Cohen kappa test was used to determine rater agreement between the pharmacist and technician second checks. The kappa value measure of inter-rater reliability between pharmacist and chemotherapy-trained pharmacy technician was excellent (kappa = 0.88, P < 0.001). They agreed 96.8% of the time, with technicians correctly identifying more errors. ConclusionThis project illustrates that chemotherapy-trained pharmacy technicians may be capable of performing chemotherapy second checks as accurately as pharmacists.

Co2 Capture for the Silicon Process-Effects of Flue Gas Recirculation

Flue gas recirculation has been proposed as a potential process improvement for the silicon and ferrosilicon process. In this paper, flue gas flows and concentration from a 100 MW silicon production operation has been calculated for 0, 25, 50, 62.5 and 75 % flue gas recirculation. Using these flue gas flows as inputs in a carbon capture model shows that specific reboiler duty can be reduced from 3,55 GJ/mtCO2 to 2,85 GJ/mtCO2 by implementing 75 % flue gas recirculation. Cost estimation of the absorber, heat exchanger and blowers indicate a potential 13,3 M$ (62 %) cost reduction between 0 and 75 % FGR.

Electrocoagulation-electrooxidation for mitigating trace organic compounds in model drinking water sources

In-situ water treatment can be accomplished using electrochemical treatments such as electrocoagulation (EC), which generates coagulants, and electrooxidation (EO), which generates oxidants (e.g., free chlorine and reactive oxygen species) via electrolysis using boron-doped diamond electrodes. In sequential EC-EO, EC can remove oxidant scavengers present in dissolved organic carbon (DOC), thereby improving the efficacy of downstream oxidation via EO. This study evaluated sequential EC-EO (and each process independently for comparison) for mitigating the trace organic compounds (TOrCs) acyclovir (ACY), trimethoprim (TMP), and benzyldimethyldecylammonium chloride (BAC-C10) in model groundwaters and surface waters. EO-only removed greater than 70% of ACY and TMP but negligible BAC-C10 in model groundwaters. In model surface waters, EO-only removed ∼55–75% BAC-C10, but had less removal for ACY and TMP (∼20–55%), primarily due to DOC interference. Sequential-EC-EO was investigated to better gauge the potential process improvement due to the addition of EC ahead of EO. EC removed 74 ± 7% DOC from model surface water and improved downstream EO treatment relative to EO-only by a factor of 3.4 for ACY, 1.7 for TMP, and 1.4 for BAC-C10. When treating model groundwater, EC-EO resulted in no improvement compared to EO-only for ACY and TMP. BAC-C10 removal was attributed to the particle separation step between EC and EO rather than electrochemical inputs. EO-only treatment was more energy efficient for model groundwater compared to model surface waters based on electrical energy per order (EEO) values. Sequential EC-EO further improved the energy efficiency for treating model river water.

An analysis of toe-to-heel air injection for heavy oil production using machine learning

With strong potential for improving productivity, economics, and efficiencies, data analytics and machine learning are rapidly emerging in the oil and gas industry. However, their application in heavy oil production is scarce. In this study, we use clustering methods to analyze the Kerrobert Toe-to-Heel Air Injection (THAI) project to understand the inter-relationships of production variables and seek for optimal operating strategy to maximize production rate. More specifically, we use the K-means, normal mixtures and hierarchical clustering methods to determine how operating parameters contribute to oil production. The results reveal that, at current operation mode, air injection rate is constrained for production maximization due to the balance between heat generation and cooling of combustion system by excess air supply. The results also provide insight for improved productivity from THAI suggesting that cyclic injection may improve process performance. The new insights demonstrate that data analytics can provide new understanding of recovery processes as well as potential process improvement.

The applicability of COBIT processes representation structure for quality improvement in healthcare: a Delphi study

In healthcare, a variety of quality management practices are used. Although they are important sources for quality improvement initiatives, they do not focus on each particular process. On the other hand, 'Control Objectives for Information and Related Technologies' (COBIT) offers a well-defined process representation structure for representing potential process improvements. The objective of this study was to adopt the COBIT structure for healthcare processes and assess the applicability of such process representations. A two-round Delphi technique was applied: in round 1, open-ended interviews were performed with the participants; in round 2, the participants responded to the web questionnaire. The participants provided their opinion between 11 September 2018 and 26 June 2019. It included 37 members of an expert panel from 8 European countries. N/A. In round 1, strengths, weaknesses, opportunities and threats indicators of using the proposed structure in healthcare were identified. These were evaluated on a 9-point Likert scale in round 2. All participants noted that elements of the COBIT process representation structure were suitable for representing healthcare processes. The consensus was reached only for strengths and opportunities indicators. A set of processes represented with the suggested structure has the potential to become a valid reference in healthcare quality improvements initiatives, as COBIT in IT domain. Despite the fact that the expert panel members confirmed the applicability of the COBIT process representation structure for healthcare processes, the identified weaknesses and threats cannot be ignored.

Virtual Farmers Markets: A Reflective Essay on a Rural Ohio Project

This reflective essay discusses the development, structure, operation, and transitioning of an online virtual farmers market in rural Ohio. In this model, customers order online and then pick up their fresh, local produce at a specified time and loca­tion. Through a combination of practitioner expe­rience in the market’s development and informal discussions with people associated with the mar­ket’s development and management, the authors analyze the positive and negative aspects of the online market structure and implementation, as well as suggest critical steps that may be necessary to export this model to other communities. They also consider potential structural and process improvements that could increase viability and success. A last-minute addendum briefly discusses the potential for this model to become a meaning­ful response to the COVID-19 issue as well.

Optimizing interventions across the HIV care continuum: A case study using process improvement analysis

UNAIDS’ 90–90–90 goal for 2020 is for 90% of HIV-infected people to know their status, 90% of infected individuals to receive antiretroviral therapy (ART), and 90% of those on ART to achieve viral suppression. To achieve these ambitious goals, effective care delivery programs are needed. In this paper we present a case study showing how HIV care can be improved by viewing the patient care process as a production process and applying methods of process improvement analysis. We examine the continuum of HIV care at a hospital-based HIV clinic in Kingston, Jamaica. We perform qualitative analysis to identify key programmatic, personnel, and clinical areas for process improvement. We then perform quantitative analysis. We develop a stochastic model of the care process which we use to evaluate the effects of potential process improvements on the number of patients who receive ART and the number who achieve viral suppression. We also develop a model for optimal investment of a fixed budget among interventions aimed at improving the care cascade and we use the model to determine the optimal investment among three interventions that the clinic could invest in. By viewing the patient care process as a production process and applying qualitative and quantitative process improvement analysis, our case study illustrates how clinics can identify the best ways to maximize clinical outcomes. Our methods are generalizable to other HIV care clinics as well as to clinics that provide care for other chronic conditions (e.g., diabetes, hepatitis B, or opioid use disorder).

Establishing a Satellite Transfusion Service Within an Academic Medical Center

Increasingly complex medical care requires specialized transfusion support close at hand. Hospital growth can necessitate expansion of blood bank services to new locations to ensure rapid delivery of blood products. We describe the opening of a new satellite transfusion service designed to serve the needs of a pediatric hospital. Institutional transition teams and stakeholders collaborated to discuss options for providing blood at a new pediatric hospital. A staffed satellite transfusion service met the diverse needs of multiple services and was considered a compromise between a full new transfusion service and automated solutions. Initial challenges in establishing the laboratory included regulatory uncertainty and interactions between two hospitals' information technology services. Laboratory scientist staffing and actual use required adapting the satellite service to an emergency release-only model. A flexibly staffed satellite transfusion service met the most urgent needs of a pediatric hospital expansion. Review of implementation revealed potential process improvements for future expansions, including comprehensive routine and massive transfusion simulations. The challenges experienced in supplying staff and specialized blood products track with national trends. Other institutions may consider establishing a satellite transfusion service in the context of both increasingly sophisticated automated solutions and complex blood needs.