Blood supply management (RBC): definitions, description as a process, tools for assessment and improvement

Abstract

BackgroundA patient‐centered vision leads to conceive all transfusion medicine activities as a “blood supply chain”, starting with patients’ needs and ending with transfusion of needed blood components (BCs) to patients. This blood supply chain comprises two main sectors: the hospitals ‐ where transfusion is ordered by clinicians and administered to patients ‐ and the suppliers, acting from donor management to BC distribution, usually Blood Establishments (BEs).The aim is to help all involved actors to assess and improve their blood supply management (BSM) for the primary benefit of patients.Materials and methodsBlood supply management, focusing on red blood cell concentrates (RBC), has been investigated by a working group (TS003 WG) of the European Committee (partial agreement) on blood transfusion (CD‐P‐TS), and also by an ISBT working party on BSM. From scientific literature, current members’ experiences and definitions of basic terms (use, demand, needs, self‐sufficiency, RBC supplier), the TS003 WG first designed BSM as a real process with the following steps. i) Assess past hospital RBC use for patients; ii) Establish a forecast for overall annual supply (BEs) and use (hospitals); iii) Establish annual blood collection program (BEs); iv) Weekly balance RBC use and supply in both BEs and hospitals; v) Review and update the patients’ RBC needs and their satisfaction. This process has been used as a basis to elaborate a questionnaire to investigate each step of the BSM process in the Council of Europe (CoE) countries, and CoE observers (Australia, Canada, New Zealand and USA)ResultsThe most striking outcomes from the survey were as following. Of 45 surveyed countries, 39 (87%) responded. The blood supply chain (BSC) structures could be classified in three main types: National BE based, 100% hospital based and mix of different organisations. Information exchange between hospitals and RBC supplier(s) was frequently lacking. A national effective coordination of BSM could be found in countries with any of the three BSC organisations. A “vein to vein” IT system covering the entire BSC appeared to be of major importance to achieve such national coordination of BSM. The results of the study have been presented and discussed at a symposium organised by the CoE in October 2012. This provided an opportunity to evaluate the use of the TS003 questionnaire, combined with a SWOT (strengths, weaknesses, opportunities and threats) analysis, to self‐assess the current status of BSM in a given country and to deduce measures for improvement. This experience, deemed very fruitful by all participating countries, can be considered as a first validation of the proposed tool and methodConclusionsThe self‐assessment TS003 questionnaire combined with a SWOT analysis may be considered as an effective tool to evaluate current situation of BSM, deduce measures for improvement and assess their effectiveness. A complementary study by the ISBT BSM WP should help to further disseminate, evaluate and improve this tool and method in a larger number of countries, and gain additional knowledge to establish Good practices in BSM, for the primary benefit of patients, and also all other involved stakeholders.