Home About us Editorial board Ahead of print Current issue Search Archives Submit article Instructions Subscribe Contacts Login 
  • Users Online:171
  • Home
  • Print this page
  • Email this page


 
 Table of Contents  
ORIGINAL ARTICLE
Year : 2020  |  Volume : 5  |  Issue : 2  |  Page : 206-208

Blood utilization quality indicators in a tertiary care center in South India


Department of Transfusion Medicine, JIPMER, Puducherry, India

Date of Submission12-Jul-2020
Date of Decision14-Sep-2020
Date of Acceptance18-Sep-2020
Date of Web Publication13-Nov-2020

Correspondence Address:
Remi Remakanth
Department of Transfusion Medicine, JIPMER, Puducherry
India
Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/GJTM.GJTM_67_20

Rights and Permissions
  Abstract 


Background: Injudicious over-ordering of blood components not only burdens the physical and human resources but also increases the cost of health care. Moreover, such practices have a greater implication in developing countries like ours where there is a scarcity of voluntary blood donors and insufficient blood supply to cater to increasing demands. Therefore, there is a need for continuous monitoring of the utilization of blood components and to audit the transfusion practices to identify areas of concern for blood usage. Ours is a 1600 bedded super specialty health center with 100% bed occupancy. The objective of the study was to analyze the trend of utilization of blood components and transfusion practices by various medical and surgical specialties by determining the blood utilization quality indicators at our center. Methods: This was a retrospective and cross-sectional study done over a period of 7 months from January 2018 to July 2018. The data for blood utilization quality indicators in the first half can be taken as the representative of the entire year. The data pertaining to the number of requisitions received as well as cross-matches done and issues made were collected from transfusion requisition forms, cross-match, and issue registers and analyzed. The parameters used in the analysis were crossmatch to transfusion ratio (CT ratio), transfusion index (TI), and transfusion probability (%T). Results: During the 7-months study period, a total of 28,317 transfusion requisitions were received and 34,701 blood components were issued. The total cross-matched red blood cell (RBC) units were 10,861 and the total RBC units transfused were 10,066. The overall C/T ratio was found to be 1.57. The transfusion probability (%T) and TI were calculated as 79% and 1.18, respectively, in our study. Conclusion: The CT ratio, transfusion probability, and TI demonstrated that there is an efficient blood utilization at our center. Regular auditing of blood transfusion services should be practiced at every hospital wherein the Maximum Surgical Blood Ordering Schedule can be modified and implemented progressively, following evidence-based blood transfusion guidelines.

Keywords: Blood utilization, cross-match to transfusion ratio, quality indicators, transfusion index, transfusion probability


How to cite this article:
Remakanth R, Abhishekh B. Blood utilization quality indicators in a tertiary care center in South India. Glob J Transfus Med 2020;5:206-8

How to cite this URL:
Remakanth R, Abhishekh B. Blood utilization quality indicators in a tertiary care center in South India. Glob J Transfus Med [serial online] 2020 [cited 2020 Nov 27];5:206-8. Available from: https://www.gjtmonline.com/text.asp?2020/5/2/206/300633




  Introduction Top


Blood for transfusion being a scarce and expensive biologic resource and associated with potentially serious noninfectious and infectious complications, irrational transfusion needs to be avoided. Injudicious over-ordering of blood components not only burdens the available resources but also increases the cost of health care, especially in developing countries with a scarcity of voluntary blood donors and insufficient blood supply to cater to the increasing demands. AABB defines quality indicators as the specific performance measurements designed to monitor one or more processes during a defined time and are useful for evaluating service demands, adequacy of personnel inventory control, and process stability.[1],[2] The literature says gross over-ordering of blood in the developing countries amounting to 40%–70% among the transfused patients.[3] Therefore, there is a need for continuous monitoring and auditing of the utilization of blood components and transfusion practices to identify areas of concern in blood usage.

Aims and objectives

The objective of the study was to evaluate the utilization of blood and the status of transfusion practices in a tertiary care center in the Southern India.


  Materials and Methods Top


This retrospective, cross-sectional audit was done over a period of 7 months from January 2018 to July 2018 in the Department of Transfusion Medicine and Immunohematology in our center. Modalities used for data collection included patient transfusion request forms, cross-match forms, issue records, and patient records.

Statistics

The data were then entered in SPSS version 20.0 (IBM SPSS Statistics for Windows, IBM Corp., Armonk, NY, USA) and analyzed through the calculation of the key indicators Crossmatch to transfusion ratio (CT ratio), TI, and %T. We focussed on the following indicators:

  1. Crossmatch to Transfusion ratio (C: T): No. of crossmatched red blood cell (RBC) units/No. of transfused RBC units
  2. Transfusion Index (TI): No. of transfused RBC units/No. of crossmatched RBC units
  3. Transfusion probability(%T): (No. of patients transfused/No. of patients crossmatched) ×100.


Ethical approval

The study has been cleared by the Institutional Ethics Committee and no patient identity is disclosed anywhere in the study.


  Results Top


Ours is a 1600 bedded super specialty health center with 100% bed occupancy throughout the year. During the 7-months period, a total of 28,317 requisitions [Table 1] were received and 34,701 different components were issued [Table 1]. The total cross-matched RBC units were 10,861 and the total RBC units transfused were 10,066. The overall C/T ratio was found to be 1.57. Blood utilization by surgical specialties was 41%, whereas medical specialties used 59% of the blood components [Figure 1]. The transfusion probability (%T) and TI were calculated as 79% and 1.18, respectively [Table 2].
Table 1: Blood component wise distribution

Click here to view
Figure 1: Blood utilization in various specialties

Click here to view
Table 2: Quality indicators for blood utilization

Click here to view



  Discussion Top


Maintaining an inventory that balances between demand and supply in a huge center like ours is a great challenge. The WHO defines an appropriate indicator as ' a variable with characteristics of quality, quantity and time, used to measure changes in health and health-related situation, directly or indirectly, the progress made in addressing it, and providing a basis for developing an adequate plan for improvement.'[4] Although various quality indicators are identified for efficient blood utilization, we took only three quality indicators for the purpose of this study, namely, CT ratio, TI, and Transfusion probability %. A CT ratio of 2.5 or below, Transfusion probability of ≥30%, and TI of >0.5 is considered indicative of efficient blood utilization.[3],[5] Our results indicate that we are doing considerably good in that aspect and more or less similar to studies available in the literature.

It was observed that blood utilization by surgical specialties was lesser (41%) than medical specialties (59%) contrary to other studies where surgical specialties utilized more blood components.[6] The reason behind this is over-ordering for single-unit RBC transfusions, no system of Computerized Physician Order Entry, and liberal use due to free of cost availability of blood in our center. It was also observed that the return of unused blood by surgical specialties was as high as 8.25%. This inadvertent over-ordering of components by surgical specialties may be attributed to no adoption of the Maximum Surgical Blood Ordering Schedule (MSBOS) and surgical blood ordering equation. We also found that only 49.5% of patients received transfusion among 58,123 patients for whom type and screen samples were sent for [Figure 2]. This causes wastage of manpower and material resources in the blood bank. Ours is a tertiary center where 100% bed occupancy is maintained throughout the year so the results obtained more or less tend to reflect the annual blood utilization as well. One of the limitations of the study would be that it is a single center-based study and may or may not comply with the observations made in other similar studies.
Figure 2: Distribution of requisitions

Click here to view


The CT ratio, transfusion probability, and TI demonstrated that there is an efficient blood utilization despite the lack of MSBOS. Regular auditing of blood transfusion services should be practiced at every hospital wherein MSBOS can be modified and implemented progressively, based on evidence-based blood transfusion guidelines. Rational ordering and the use of blood components and improving the patient blood management protocols will contribute towards filling up the gap between demand and supply.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Devi KM, Sharma AB, Singh LD, Vijayanta K, Lalhriatpuii ST, Singh AM. Quality indicators of blood utilization in the tertiary care center in the north-eastern India. J Dent Med Sci. 2014;13:50-2.  Back to cited text no. 1
    
2.
In: Roback JD, Grossman BJ, Harris T, Hillyer CD. Editors. Technical Manual. 17th ed. Bethesda, Maryland: American Association of Blood Banks; 2011. p. 24.  Back to cited text no. 2
    
3.
Kozarzewska M, Maćkowiak M, Steler J, Krefta M, Hasak L, Kardel-Reszkiewicz E. The analysis of surgical blood order protocol. Anestezjol Intens Ter 2011;43:71-3.  Back to cited text no. 3
    
4.
Safe Blood and Blood Products: indicators and Quality of Care. World Health Organization, Regional Office for the Western Pacific, Manila, Philippines; 1996.  Back to cited text no. 4
    
5.
Kaur D, Kandwal M. Blood utilization and quality indicators-trend at a super specialty hospital in Northern India. Hematol Transfus Int J 2016;2:53-6.  Back to cited text no. 5
    
6.
Friedman BA, Oberman HA, Chadwick AR, Kingdon KI. The maximum surgical blood order schedule and surgical blood use in the United States. Transfusion 1976;16:380-7.  Back to cited text no. 6
    


    Figures

  [Figure 1], [Figure 2]
 
 
    Tables

  [Table 1], [Table 2]



 

Top
 
 
  Search
 
Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
 Related articles
Access Statistics
Email Alert *
Add to My List *
* Registration required (free)

 
  In this article
Abstract
Introduction
Materials and Me...
Results
Discussion
References
Article Figures
Article Tables

 Article Access Statistics
    Viewed44    
    Printed2    
    Emailed0    
    PDF Downloaded9    
    Comments [Add]    

Recommend this journal


[TAG2]
[TAG3]
[TAG4]