Making every drop count: reducing wastage of a novel blood component for transfusion of trauma patients

BMJ Open Quality

article

Josephine McCullagh¹  Nathan Proudlove³  Harriet Tucker⁴  Jane Davies⁵  Dave Edmondson⁵  Julia Lancut²  Angela Maddison²  Anne Weaver⁶  Ross Davenport⁴  Laura Green² 

[1] NHS Higher Specialist Scientist Training ,(HSST), DClinSci Programme , The University of Manchester;Pathology , Barts Health NHS Trust;Alliance Manchester Business School , The University of Manchester;Blizard Institute , Queen Mary, University of London;Manufacturing and Development;Major Trauma Centre , Barts Health NHS Trust;Blood Component Department

关键词: prehospital care;    advanced trauma life support care;    control charts/run charts;    quality improvement;    emergency department;   

DOI  :  10.1136/bmjoq-2021-001396

学科分类：药学

来源: BMJ Publishing Group

【 摘 要 】

Recent research demonstrates that transfusing whole blood (WB=red blood cells (RBC)+plasma+platelets) rather than just RBC (which is current National Health Service (NHS) practice) may improve outcomes for major trauma patients. As part of a programme to investigate provision of WB, NHS Blood and Transplant undertook a 2-year feasibility study to supply the Royal London Hospital (RLH) with (group O negative, ‘O neg’) leucodepleted red cell and plasma (LD-RCP) for transfusion of trauma patients with major haemorrhage in prehospital settings.Incidents requiring such prehospital transfusion occur randomly, with very high variation. Availability is critical, but O neg LD-RCP is a scarce resource and has a limited shelf life (14 days) after which it must be disposed of. The consequences of wastage are the opportunity cost of loss of overall treatment capacity across the NHS and reputational damage.The context was this feasibility study, set up to assess deliverability to RLH and subsequent wastage levels. Within this, we conducted a quality improvement project, which aimed to reduce the wastage of LD-RCP to no more than 8% (ie, 1 of the 12 units delivered per week).Over this 2-year period, we reduced wastage from a weekly average of 70%–27%. This was achieved over four improvement cycles. The largest improvement came from moving near-expiry LD-RCP to the emergency department (ED) for use with their trauma patients, with subsequent improvements from embedding use in ED as routine practice, introducing a dedicated LD-RCP delivery schedule (which increased the units ≤2 days old at delivery from 42% to 83%) and aligning this delivery schedule to cover two cycles of peak demand (Fridays and Saturdays).prehospital careadvanced trauma life support carecontrol charts/run chartsquality improvementemergency departmentData availability statementAll data relevant to the study are included in the article.http://creativecommons.org/licenses/by-nc/4.0/This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

【 授权许可】

CC BY-NC|CC BY|CC BY-NC-ND