Blood Inventory Management: Hospital Best Practice

A study on blood product usage and wastage at the public hospital, Guyana

BACKGROUND

Blood is a valuable resource and blood wastage in a low socio economic country could impose a very serious impact on healthcare. This study therefore analyzes the usage and wastage of blood and blood products at the Georgetown Public Hospital Cooperation (GPHC), Guyana.

METHODS

A retrospective study was conducted on the data retrieved from laboratory blood banking information system on usage and wastage of blood products during the years 2012-2014 at the public hospital. The data were analyzed in MS Excel and SPSS 20.0.

RESULTS

A total of 16,426 units of blood were issued from National Blood Transfusion Services. During the study period the most frequently requested blood component was packed cells followed by fresh frozen plasma (FFP), platelet, cryoprecipitate (CRYO) and whole blood respectively. Data indicated that 4167 units (25 %) of blood were wasted due to various reasons at GPHC.

CONCLUSIONS

There is a need for intervention through raising awareness among medical staff in reducing blood wastage.

Segregation of blood inventory: A key driver for optimum blood stock management in a resource-poor setting

BACKGROUND

Blood inventory management entails maintaining a delicate balance between guaranteeing blood availability and minimizing wastage. The study was conducted to identify and analyze various factors of wastage which can provide insight to ideal inventory management, thus help in formulating policies and improve efficiency of blood transfusion services.

MATERIALS AND METHODS

The study was conducted in a tertiary care hospital. To determine various causes of wastage, a retrospective analysis was done over 6 months and preventive strategies adopted. Issuable stock index (ISI) and wastage as percentage of issue (WAPI) were used to compare the effect on blood inventory before and after adoption of strategies. The average number of times each ABO group and Rh type was crossmatched before final transfusion was calculated and compared for randomly selected units over the first 6 months of 2012 and 2013.

RESULTS

Outdating was found to be the largest cause, and decrease in discarding rate was observed after adoption of strategies. Mean ISI for different study periods was comparable. However, significant decrease (P = 0.015) was observed for WAPI and WAPI with respect to outdating. Significant decrease in average number of times a unit was crossmatched before final transfusion for all positive blood groups and O-negative blood group was observed over corresponding first 6 months of 2012 and 2013.

CONCLUSION

Division of inventory into two parts, enlistment of soon to outdate blood components, and reduction of holding of blood units to minimum period for elective surgery patients are simple measures which can minimize wastage.

High performing hospitals: a qualitative systematic review of associated factors and practical strategies for improvement

BACKGROUND

High performing hospitals attain excellence across multiple measures of performance and multiple departments. Studying high performing hospitals can be valuable if factors associated with high performance can be identified and applied. Factors leading to high performance are complex and an exclusive quantitative approach may fail to identify richly descriptive or relevant contextual factors. The objective of this study was to undertake a systematic review of qualitative literature to identify methods used to identify high performing hospitals, the factors associated with high performers, and practical strategies for improvement.

METHODS

Methods used to collect and summarise the evidence contributing to this review followed the 'enhancing transparency in reporting the synthesis of qualitative research' protocol. Peer reviewed studies were identified through Medline, Embase and Cinahl (Jan 2000-Feb 2014) using specified key words, subject terms, and medical subject headings. Eligible studies required the use of a quantitative method to identify high performing hospitals, and qualitative methods or tools to identify factors associated with high performing hospitals or hospital departments. Title, abstract, and full text screening was undertaken by four reviewers, and inter-rater reliability statistics were calculated for each review phase. Risk of bias was assessed. Following data extraction, thematic syntheses identified contextual factors important for explaining success. Practical strategies for achieving high performance were then mapped against the identified themes.

RESULTS

A total of 19 studies from a possible 11,428 were included in the review. A range of process, output, outcome and other indicators were used to identify high performing hospitals. Seven themes representing factors associated with high performance (and 25 sub-themes) emerged from the thematic syntheses: positive organisational culture, senior management support, effective performance monitoring, building and maintaining a proficient workforce, effective leaders across the organisation, expertise-driven practice, and interdisciplinary teamwork. Fifty six practical strategies for achieving high performance were catalogued.

CONCLUSIONS

This review provides insights into methods used to identify high performing hospitals, and yields ideas about the factors important for success. It highlights the need to advance approaches for understanding what constitutes high performance and how to harness factors associated with high performance.

Transfusion of fresher versus older red blood cells for all conditions

BACKGROUND

Red blood cell transfusion is a common treatment for anaemia in many clinical conditions. One current concern is uncertainty as to the clinical consequences (notably efficacy and safety) of transfusing red blood cell units that have been stored for different durations of time before a transfusion. If evidence from randomised controlled trials were to indicate that clinical outcomes are affected by storage age, the implications for inventory management and clinical practice would be significant.

OBJECTIVES

To assess the effects of using fresher versus older red blood cells in people requiring a red blood cell transfusion.

SEARCH METHODS

We ran the search on 29th September 2014. We searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE (OvidSP), Embase (OvidSP), CINAHL (EBSCO), PubMed (for e-publications), three other databases and trial registers.

SELECTION CRITERIA

We included randomised controlled trials comparing fresher red blood cell transfusion versus active transfusion of older red blood cells, and comparing fresher red blood cell transfusion versus current standard practice. All definitions of 'fresher' and 'older'/'standard practice' red blood cells were included.

DATA COLLECTION AND ANALYSIS

Two review authors independently assessed trial quality and extracted from the trial report data on adverse red blood cell transfusion reactions, when reported.

MAIN RESULTS

We included 16 trials (1864 participants) in the review. Eight trials (279 participants) compared transfusion of fresher red blood cells versus transfusion of older stored red blood cells ('fresher' vs 'older'). Eight trials (1585 participants) compared the transfusion of fresher red blood cells versus current standard practice ('fresher' vs 'standard practice'). Five trials enrolled neonates, one trial enrolled children and 12 trials enrolled adults. Overall sample sizes were small: only two trials randomly assigned more than 100 participants.We performed no meta-analyses for a variety of reasons: no uniform definition of 'fresher' or 'older' red blood cell storage; overlap in the distribution of the age of red blood cells; and heterogeneity in measurements and reporting of outcomes of interest to this review. We tabulated and reported results by individual trial. Overall risk of bias was low or unclear, with four incidences of high risk of bias: in allocation concealment (three trials) and in incomplete outcome data (one trial).No trial measured all of the outcomes of interest in this review. Four trials comparing 'fresher' with 'older' red blood cells reported the primary outcome: mortality within seven days (one study; 74 participants) and at 30 days (three trials; 62 participants). Six trials comparing 'fresher' with 'standard practice' red blood cells reported the primary outcome: mortality within seven days (three studies; 159 participants) and at 30 days (three trials; 1018 participants). All 10 trials reported no clear differences in mortality at either time point between intervention arms.Three trials comparing 'fresher' with 'standard practice' red blood cells reported red blood cell transfusion-associated adverse events. No adverse reactions were reported in two trials, and one incidence of cytomegalovirus (CMV) infection was described in the 'standard practice' arm in one trial.Overall the trials reported no clear difference between either of the intervention comparisons in long-term mortality (three trials; 478 participants); clinically accepted measures of multiple organ dysfunction (two trials: 399 participants); incidence of in-hospital infection (two trials; 429 participants); duration of mechanical ventilation (three trials: 95 participants); and number of participants requiring respiratory organ support (five trials; 528 participants) or renal support (one trial; 57 participants). The outcome 'physiological markers of oxygen consumption or alterations in microcirculation' was reported by 11 studies, but the measures used were highly varied, and no formal statistical analysis was undertaken.

AUTHORS' CONCLUSIONS

Several factors precluded firm conclusions about the clinical outcomes of transfusing red blood cell units that have been stored for different periods of time before transfusion, including differences in clinical population and setting, diversity in the interventions used, methodological limitations and differences in how outcomes were measured and reported.No clear differences in the primary outcome - death - were noted between 'fresher' and 'older' or 'standard practice' red blood cells in trials that reported this outcome. Findings of a large number of ongoing trials will be incorporated into this review when they are published.Updates of this review will explore the degree of overlap in trials between 'fresher', 'older' and 'standard practice' storage ages of red blood cells and will consider whether the size of any observed effects is dependent on recipient factors such as clinical background, patient age or clinical presentation.

Effectiveness of multiple initiatives to reduce blood component wastage

OBJECTIVES

Blood component waste is an important issue at all hospitals. As an initiative of the patient blood management program at a regional health care system, the causes and extent of blood product wastage were identified, and targeted interventions to effect a reduction were implemented.

METHODS

Multiple low-cost interventions, including educational outreach, print and digital messaging, and improved transportation and component identification modalities, were implemented beginning in January 2013. The impact on reducing RBC, platelet (PLT), and plasma wastage in the 16 months after intervention implementation was compared with the wastage rates in the 16 months before these interventions had been implemented.

RESULTS

Overall, the RBC wastage rate as a percentage of the number of units issued decreased from 0.67% to 0.56% (P = .001) after the interventions were implemented, while the PLT wastage rate decreased from 3.71% to 2.81% (P < .001). The plasma wastage rate increased from 1.14% to 1.40% (P < .001). The initial cost of these interventions was approximately $310. The net cost savings of the reduced waste was estimated at $131,520, excluding intervention costs.

CONCLUSIONS

Relatively inexpensive interventions can have a prompt and dramatic impact on reducing blood wastage with regard to both cost and resource savings.

Challenges in the management of the blood supply

Although blood suppliers are seeing short-term reductions in blood demand as a result of initiatives in patient blood management, modelling suggests that during the next 5-10 years, blood availability in developed countries will need to increase again to meet the demands of ageing populations. Increasing of the blood supply raises many challenges; new approaches to recruitment and retainment of future generations of blood donors will be needed, and care will be necessary to avoid taking too much blood from these donors. Integrated approaches in blood stock management between transfusion services and hospitals will be important to minimise wastage--eg, by use of supply chain solutions from industry. Cross-disciplinary systems for patient blood management need to be developed to lessen the need for transfusion--eg, by early identification and reversal of anaemia with haematinics or by reversal of the underlying cause. Personalised medicine could be applied to match donors to patients, not only with extended blood typing, but also by using genetically determined storage characteristics of blood components. Growing of red cells or platelets in large quantities from stem cells is a possibility in the future, but challenges of cost, scaling up, and reproducibility remain to be solved.

Factors affecting red blood cell storage age at the time of transfusion

BACKGROUND

Clinical trials are investigating the potential benefit resulting from a reduced maximum storage interval for red blood cells (RBCs). The key drivers that determine RBC age at the time of issue vary among individual hospitals. Although progressive reduction in the maximum storage period of RBCs would be expected to result in smaller hospital inventories and reduced blood availability, the magnitude of the effect is unknown.

STUDY DESIGN AND METHODS

Data on current hospital blood inventories were collected from 11 hospitals and three blood centers in five nations. A general predictive model for the age of RBCs at the time of issue was developed based on considerations of demand for RBCs in the hospital.

RESULTS

Age of RBCs at issue is sensitive to the following factors: ABO group, storage age at the time of receipt by the hospital, the restock interval, inventory reserve, mean demand, and variation in demand.

CONCLUSIONS

A simple model, based on hospital demand, may serve as the basis for examining factors affecting the storage age of RBCs in hospital inventories. The model suggests that the age of RBCs at the time of their issue to the patient depends on factors external to the hospital transfusion service. Any substantial change in the expiration date of stored RBCs will need to address the broad variation in demand for RBCs while attempting to balance considerations of availability and blood wastage.