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| ORIGINAL ARTICLE |
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| Year : 2020 | Volume
: 5
| Issue : 2 | Page : 206-208 |
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Blood utilization quality indicators in a tertiary care center in South India
Remi Remakanth, B Abhishekh
Department of Transfusion Medicine, JIPMER, Puducherry, India
| Date of Submission | 12-Jul-2020 |
| Date of Decision | 14-Sep-2020 |
| Date of Acceptance | 18-Sep-2020 |
| Date of Web Publication | 13-Nov-2020 |
Correspondence Address:
Remi Remakanth
Department of Transfusion Medicine, JIPMER, Puducherry
India
 Source of Support: None, Conflict of Interest: None  | Check |
DOI: 10.4103/GJTM.GJTM_67_20
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 |
| Introduction | |  |
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 | | |
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:
- Crossmatch to Transfusion ratio (C: T): No. of crossmatched red blood cell (RBC) units/No. of transfused RBC units
- Transfusion Index (TI): No. of transfused RBC units/No. of crossmatched RBC units
- 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 | | |
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].
| Discussion | | |
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.
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 | | |
| 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.  |
| 2. | In: Roback JD, Grossman BJ, Harris T, Hillyer CD. Editors. Technical Manual. 17 th ed. Bethesda, Maryland: American Association of Blood Banks; 2011. p. 24. |
| 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. |
| 4. | Safe Blood and Blood Products: indicators and Quality of Care. World Health Organization, Regional Office for the Western Pacific, Manila, Philippines; 1996. |
| 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. |
| 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. |
[Figure 1], [Figure 2]
[Table 1], [Table 2]
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