Comparing transfusion practice at multiple hospitals using electronically collected and analysed data.

BACKGROUND: Comparisons of transfusion practice between organisations are time-consuming using manual methods for data collection. We performed a feasibility study to determine whether large-scale transfusion data from three English hospitals could be combined to allow comparisons of transfusion practice. METHODS: Clinical, laboratory and transfusion data from patients discharged between 1 April 2016 and 31 March 2017 were extracted from Patient Administration Systems (PAS), Laboratory Information Management Systems (LIMS), and electronic transfusion systems at three NHS hospitals, which are academic medical centres based in large cities outside London. A centralised database and business intelligence software were used to compare the data. RESULTS: The dataset contained 748 982 episodes of patient care with 91 410 blood components transfused. The study confirms the results of previous studies finding peaks in the ages of transfusion in the 0-4 years age range, in women of childbearing ages, and in males over 60 years. The number of components transfused per 1000 bed days was used as a standardised comparator. Red cell utilisation was 42.4, 40.4 and 49.5 units/1000 bed days and platelet utilisation 11.69, 7.76, and 11.66 units/1000 bed days. 60.5% (6848/11 310) of Group O D negative red cell units were transfused to non-group O D negative recipients. An analysis of component usage highlighted variations in practice, for example platelet usage for cardiac surgery varied from 2.4% to 7.3% across the three hospitals. CONCLUSION: This feasibility study demonstrates that large electronic datasets from hospitals can be combined to identify areas for targeted interventions to improve transfusion practice.

Insights from developing and evaluating the NHS blood choices transfusion app to support junior and middle-grade doctor decision making against guidelines.

OBJECTIVES: To: 1. Develop a CE-marked smartphone App to support doctors' concordance with transfusion guidelines in non-bleeding adult patients, emphasising informed consent and anaemia management. 2. Test App accuracy and potential to improve user decisions. BACKGROUND: Studies have shown inappropriate use of blood components and that most junior doctors own smartphones with medical apps. METHODS: A multidisciplinary team developed App screens and logic through an iterative process based on national guidelines. Thirty medical or surgical transfusion scenarios were developed based on national guidelines and each sent to Consultant Haematologist experts in Transfusion Medicine. To obtain a clinical consensus and exclude ambiguous scenarios, their independent decisions and associated certainty were compared. The consensus clinical decision was then compared with guidance from the App. To explore potential App impact on simulated user decisions, 26 junior doctors responded to five transfusion scenarios before and after access to the App. RESULTS: The Blood Choices App agreed with 91% (95% CI: 72%-99%) of expert decisions with a sensitivity of 100% (69% to 100%) and specificity of 85% (55%-98%). Excluding one malfunction scenario, the App had the potential to increase correct decisions by junior doctors from 83% (73%-90%) pre-App use to 96% (88%-99%) post (p-value 0.013), with 90% (67%-99%) saying they would use it in practice. CONCLUSIONS: Transfusion guidelines can be converted into an App with potential to improve guideline concordance. However, evaluating such Apps is essential to understand their limitations, detect malfunctions and prevent harm.

A survey of transfusion practitioners in international society of blood transfusion member countries.

BACKGROUND: Transfusion Practitioner (TP) is a term that describes activities undertaken by a variety of healthcare professionals who play a key role in supporting safe and appropriate blood management/transfusion care for patients. There is significant variation in staff specialty filling the role. To understand which countries have the TP role, and the variations that exist, an international survey was undertaken in 2017. METHODS: A survey was developed by the TP Forum Steering Committee (TPFSC) with input from the International Society of Blood Transfusion (ISBT) Clinical Transfusion Working Party. The survey was distributed by the ISBT Office to all ISBT members and promoted via newsletters and social media. RESULTS/DISCUSSION: Five hundred and eighty-two responses received from 84 different countries. The TP role exists in 67 countries, 10 countries do not have the TP role, one was unaware of the role, and respondents from six other countries did not answer this question. The most prevalent TP activities reported were policy and procedure development, education, participation in Transfusion Committees and audit activities. Eighty-eight respondents indicated they did not have a TP role, with the main barrier being financial, followed by lack of support for the role. Eight respondents indicated they previously had a TP, and this role was no longer in place due to lack of support for the role, cutbacks and other priorities. CONCLUSION: This survey provides insights as to where and how the TP functions and provides the TPFSC with valuable information to develop tools to support further development of the role.