SI24 Quality Improvements on Transfusion Practice. The Role of a National Blood Use Reporting System

Abstract

Introduction and Background The development of a sustainable system that would provide information about the clinical use of blood was a requirement of the Better Blood Transfusion Programme (BBTP). The system was to be designed to identify variations in practice, encourage clinical review of blood used and contribute to the goal of reducing avoidable transfusions. The system would assist with achieving the target of reducing the population exposure to Red Blood Cells (RBCs) by 10%, this translates to the achievement of a target of 41 RBC units transfused per 1000 population.Study Design The sustainable system has been developed and named STED (Scottish Transfusion Epidemiology Database). Hospital Blood Bank records are regularly extracted from the majority of hospital blood banks in Scotland. The records are then linked to hospital inpatient and day case records (SMR1) records by probability matching based on patient details (name, address, postcode, date of birth). The linked datasets are available for analysis in an Oracle data warehouse and the Business Objects reporting suite enables NHSS wide access to the datasets.Results The initial development of STED has been to provide access to a surgical view of RBCs. Surgical blood use reports at a National, Divisional, Hospital and Consultant level has enabled clinical review of blood use across Scotland. The project is in its early stages and evaluation must take account of other initiatives for better transfusion as well as environmental factors over recent years. The programme and results, mainly related to surgical interventions has so far been presented to 21 groups of practitioners (totalling 380 individuals), in 15 hospitals. For most this was the opportunity to view local practice data in the context of other centres in the NHSS. 49 groups of operations likely to be transfused have been identified based on OPCS groups and from 2002/03 to 2004/05 the probability of transfusion for patients in these groups has reduced from 14.3% to 11.2% and the average RBC per operation has reduced from 0.6 to 0.4 during the same time period. New actions and projects can be directly attributable to STED development including a project to explore relationships between transfusion and mortality data in cardiac surgery patients. The reports are supporting business case development for support of cell salvage in Cardiac Surgery and to evaluate the effectiveness of salvage in revision hip surgery. The reports are also being used as a resource for Transfusion Practitioners of the BBTP to support local audit work.Conclusion The results reflect the combined effect of BBTP interventions and other influences. Further data will be presented on changes in blood use for surgical and nonsurgical patient groups, in addition to current developments in the programme.