Revisit of efficiency of blood usage – Need for continuous audit

Abstract

Background: The most common indices assessing blood usage are crossmatch-to-transfusion (C/T) ratio, transfusion probability (%T), Transfusion Index (TI), nonusage probability (NUP), and wastage as percentage of issue (WAPI). This study, in a South Indian tertiary care hospital, audits blood utilization efficiency and revisits it after implementing corrective measures for deficiencies identified by the first audit highlighting the importance of continuous surveillance and proper measures in efficient blood utilization. Materials and Methods: Blood utilization over 6 months, assessed by C/T ratio, TI, %T, and NUP indicated inefficient blood usage (high C/T ratio). After initiating appropriate measures, reaudit over 1 month assessed effect on blood usage. The total duration was from December 2017 to November 2018. Request forms packed red blood cells provided patient demographics, number of units requested, and indication. Blood bank records provided number of units crossmatched and issued against each request. Results: Initial audit: total requests- 4450, C:T ratio-3.6, TI-0.5, %T- 32% and NUP- 72%. Reaudit: Total requests-948 (medical 52%, surgical 48%), Overall monthly WAPI- 0.1%, C:T ratio-2.4 (medical 1.3, surgical 3.5), %T-63.5%(medical 84%, surgical 43%), TI-1 (medical 1.4, surgical 0.6), NUP- 24% (medical- 11%, surgical 37%) C/T ratio – no subspecialty crossed the highest acceptable value (2.5) except gynecology and obstetrics (4.1) and pediatric surgery (2.75). All departments met the lowest acceptable %T (30%) except G&O (25.2%). All departments met minimum TI (0.5) except G&O (0.3), pediatric surgery (0.47), and surgical super specialties (0.3). Conclusion: Initial audit showed inefficient blood utilization. Appropriate steps taken to improve this included the establishment of standard protocols. Reaudit showed efficient blood utilization in medical departments and the need for further revision in practices for surgical departments. Hence, continuous monitoring is vital in ensuring effective blood usage.