Platelet Wastage Research Articles

Impact of Implementing a Standard Operating Procedure to Reduce Blood Wastage in Blood Centers of Iran.

Blood wastage leads to additional costs and reduced blood availability to patients. Above all is the moral issue of wasting donor gifts. This study aimed to determine the rate of blood wastage before and after implementing a new standard operating procedure (SOP) in Iran. In this interventional study, a SOP for wastage management was prepared and implemented in all blood centers throughout the country. Data were extracted from the integrated software of the Iranian Blood Transfusion Organization (IBTO). The wastage rate of blood components in the post-intervention years (2016-2017) was then compared with that in the pre-intervention years (2013-2015) using the Z test. The overall wastage rate decreased by 36.86% (P<0.001, 95% CI [36.84-36.88]) after the intervention. Red blood cell (RBC) wastage decreased from 2.6% to 2.5%, platelet wastage from 19.5% to 10.6% and plasma wastage from 15.5% to 7.3% (P<0.001). The highest percentage of waste reduction pertained to plasma components, which decreased by 52.90% (P<0.001, 95% CI [52.86-52.94]). Expiration was the most common cause of RBC and platelet wastage. The most common causes of plasma wastage were RBC contamination and rupture or leakage of the bags. The intervention resulted in a drop of over 250000 discarded components each year, equal to approximately thirty-six million dollars in savings. This intervention effectively reduced waste and increased efficiency. Ongoing blood wastage reviews, auditing, and receiving feedback from the central headquarters were powerful tools in following the compliance of blood centers. Further studies are recommended, especially concerning blood wastage in hospital blood banks and various wards.

The operational impact of introducing cold stored platelets.

Cold stored platelets (CSP) undergo physical changes that make them better at initiating a clot. While cold stored platelets are superior for reducing bleeding in actively bleeding patients, room temperature platelets (RTP) are better for increasing platelet count in patients requiring a prophylactic transfusion. However, whether the overhead required to maintain a dual platelet inventory of both RTP and CSP could be compensated by reduced platelet wastage resulting from the longer shelf life of CSP has not been determined. A simulation model of a regional blood supply was built, with focus on the operations of a case hospital. Two scenarios were considered: "No-CSP," in which the hospital issues only RTP, and "CSP," in which the hospital issues both RTP and CSP Within the CSP scenario, conditions were tested under which the hospital receives only RTP and converts some to cold stored platelets and a second strategy where the hospital receives CSP from the regional supplier in addition to converting RTP. A centralized supply of CSP is necessary since on-site conversion is limited by platelet age. Product shortages decrease with increased CSP inventory, but CSP wastage increases. It was also determined that, because relatively few RTP units can be converted on-site, RTP wastage is not significantly decreased with the introduction of CSP. Given the clinical benefits for treatment of trauma, CSP is a desirable addition to a blood formulary. However, it is unlikely that significant reductions in RTP wastage will occur because of the introduction of CSP.

P‐TS‐66 | Platelet Inventory Strategy to Reduce Platelet Wastage and Costs in a Suburban Academic Medical Center

P‐TS‐66 | Platelet Inventory Strategy to Reduce Platelet Wastage and Costs in a Suburban Academic Medical Center

Pilot Study of Centralized Management System in Shanghai: A Promising Solution to Platelet Collection and Supply Imbalance in Small Blood Banks

Background and Objectives: While there exists a significant wastage of platelets on one side (volatile demands and short lifetime), there is also a shortage for use on the other (lack of donors and emergency transfusions). A new centralized management system was established to tackle this dilemma. Methods: To assess the function of this system, data were collected from the Fengxian Blood Bank (FBB) Collection and Supply Information System during 2016 and 2018, then analyzed by IBM SPSS Statistics version 20. Results: Since implementing the centralized management system, a total of 1340 units of apheresis platelets were distributed by FBB. However, the number of units collected was 2737, twice as much as what had been distributed. With the aid of the system, the excess of 1644 units of apheresis platelets were transferred to the Shanghai Blood Center (SBC) inventory at their disposal. On the other hand, 247 units (included in 1340 distributed units) were compensated by SBC during the platelet shortage. In addition, the hospital demand meeting rate shows a significant increase from 82.61% to 99.78%, especially for type AB which increases from 62% to 100%. Conclusions: In conclusion, the centralized management system vastly improved the efficiency of platelet collection and distribution by the regional supply and demand. Such success would be a superb example of blood banks facing similar problems.

Project S.T.O.P (Stop the Over-ordering of Platelets): An initiative to reduce platelet wastages for pediatric open-heart surgeries

IntroductionDue to a national policy change in the management of unused platelet units from September 2018, there was a drastic increase in the number of platelet units wasted in our institution. MethodsUsing Quality Improvement (QI) tools, platelet wastages from pediatric heart surgeries was identified as a priority area to work on. An intervention based on the creation of ‘Order Sets’ for pediatric open-heart surgeries was implemented, standardizing standby platelet orders based on type of surgery and patient weight. ResultsThis intervention led to a dramatic improvement in the number of platelets ordered on standby, and consequently a decrease in platelet wastage from 47.6% to 16.9% for pediatric open-heart surgeries, without any reported adverse events. ConclusionWith the creation of Order Sets and continuous education, it was possible to eradicate the practice of requesting unnecessary standby platelets for surgeries. This is an effective patient blood management (PBM) strategy resulting in a significant decrease in platelet wastage rate and substantial cost savings.

Inventory Sharing for Perishable Products: Application to Platelet Inventory Management in Hospital Blood Banks

A Simple and Provably Good Inventory Policy Led to a Significant Reduction in Platelet Outdates Platelets are critical blood products. The management of platelet inventory is particularly challenging because of its perishable nature with a short shelf life. This paper studies how the wastage of platelets and, more broadly, perishable products can be reduced through inventory sharing. The authors derive structural results on the optimal ordering and transshipment policies for a two-location perishable inventory system and prove that an easy-to-implement myopic transshipment policy is optimal for a few special cases relevant to practice and serves as a lower bound on the optimal transshipment policy for more general settings. This policy has been successfully implemented by the Emory University Hospital System, which led to a reduction of approximately 20% in platelet outdates. Moreover, this paper also sheds light on how the presence of inventory sharing affects the optimal ordering quantities and provides insights that significant depart from existing findings for nonperishable inventory systems.

Design and logistical considerations for the randomized adaptive non-inferiority storage-duration-ranging CHIlled Platelet Study.

Platelet transfusion is a potentially life-saving therapy for actively bleeding patients, ranging from those undergoing planned surgical procedures to those suffering unexpected traumatic injuries. Platelets are currently stored at room temperature (20°C-24°C) with a maximum storage duration of 7 days after donation. The CHIlled Platelet Study trial will compare the efficacy and safety of standard room temperature-stored platelets with platelets that are cold-stored (1°C-6°C), that is, chilled, with a maximum of storage up to 21 days in adult and pediatric patients undergoing complex cardiac surgical procedures. CHIlled Platelet Study will use a Bayesian adaptive design to identify the range of cold storage durations for platelets that are non-inferior to standard room temperature-stored platelets. If cold-stored platelets are non-inferior at durations greater than 7 days, a gated superiority analysis will identify durations for which cold-stored platelets may be superior to standard platelets. We present example simulations of the CHIlled Platelet Study design and discuss unique challenges in trial implementation. The CHIlled Platelet Study trial has been funded and will be implemented in approximately 20 clinical centers. Early randomization to enable procurement of cold-stored platelets with different storage durations will be required, as well as a platelet tracking system to eliminate platelet wastage and maximize trial efficiency and economy. The CHIlled Platelet Study trial will determine whether cold-stored platelets are non-inferior to platelets stored at room temperature, and if so, will determine the maximum duration (up to 21 days) of storage that maintains non-inferiority. ClinicalTrials.gov, NCT04834414.

Improvement in Platelet Product Wastage and Reduction of Costs through Implementation of the Pan Genera Detection Test.

The aim of this study was to evaluate the effects of Pan Genera Detection (PGD) testing on reducing platelet product wastage and transfusion service costs. We conducted a retrospective cross-sectional study comparing the number of platelet apheresis units wasted before (March 2017 to February 2019) and after (March 2019 to February 2021) PGD implementation. The PGD testing was performed before transfusion on days 6 and 7. Cost analysis considered the costs of platelet units wasted ($500.00/unit) and PGD test supplies and performance (estimated $26.50 per test). Paired samples t-test was used to compare platelet wastage pre- and post-PGD implementation. The number of wasted platelet units decreased from pre-PGD (419) to post-PGD (195), representing a significant decrease in platelet wastage from 17.5% to 9.2% (P < .0001). During the post-PGD period, 366 and 133 units were tested on days 6 and 7, with 28 and 36 units discarded each day, allowing transfusion of an additional 302 platelet units. Costs from platelet wastage decreased from $209,500.00 pre-PGD to $97,500.00 post-PGD. Our results showed that PGD testing effectively reduced platelet wastage, extended platelet availability, and reduced transfusion service costs.

Reducing platelet wastage in a regional Australian haematology centre: Impact of phone calls to clinical staff for expiring platelet stock

Background: Inventory management of platelets is critically important to avoid shortage and minimise wastage.1 In our centre this is challenging with a platelet order to delivery time of 12–24 hours and no other stock within a 400 km radius. Aim: To examine if phoning clinical haematology staff reduced platelet wastage. Methods: Our senior transfusion scientist introduced routine calls to haematology clinical staff when platelets were expiring in the next 12 hours. We compared Discards as Percentage Issued (DAPI) published in National Blood Authority reports for July–December 2016 prior to the intervention with DAPI for July–December 2018 after this intervention was routinely established. Excel spread sheets of platelet inventory and logs of phone calls to clinicians were also reviewed. Results: We observed an absolute reduction of 9.2% in DAPI between the two time periods (23.0% July–December 2018 vs 32.2% for July–December 2016). From July–December 2018 66 phone calls were made to clinical staff regarding expiring platelet stock. The total number of platelets issued in the two time periods was similar (391 July–December 2016 vs 387 July–December 2018). Discussion: Our results demonstrate a simple yet effective best practice inventory management strategy to reduce platelet wastage. We are not aware of any other centres who are utilising this strategy. Reference 1. National Blood Authority. National Blood and Blood Product Wastage Reduction Strategy 2013–2017. Canberra: National Blood Authority, 2013. https://www.blood.gov.au/system/files/documents/nba-wastage-strategy.pdf

A Quality Approach to Reducing the Occurrence of Occluded Leukocyte Reduction Filters During Platelet Transfusion.

In 2019, an increase in clotted platelet filter occurrences was noted with the implementation of new leukocyte reduction filters through a volumetric pump. Occluded platelet filters contribute to delays in platelet transfusions, additional nursing workflows, and potential wastage of platelets, leading to staff and patient dissatisfaction. Direct observation of nursing practice with priming platelet filters identified opportunities for improvement. Education was designed incorporating manufacturer recommendations with results of the observations. Nursing education was disseminated through small group sessions, one-to-one teaching, tip sheets, and an e-learning video. Nursing education interventions resulted in a 170% reduction in the reported monthly filter occlusion rate. Engagement of nurses in quality improvement processes and collaboration across departments led to a sustained decrease in the clotted platelet filters.

Multicenter observational study evaluating the impact of platelet transport bags on product wastage.

Platelets are the most commonly discarded blood product in Canada, with the most common cause of in-date product loss being improper storage. Transport containers to maintain temperature and extend acceptable return time may represent a method to reduce wastage. The objective of this study was to evaluate the impact of a validated Platelet Transport Bag (PTB) on platelet wastage. Thirty-six hospitals with the highest platelet discards were invited to participate in a before-after observational study. Hospitals were instructed to utilize a validated 4-h PTB for clinical situations where immediate transfusion was not planned. Five hospitals audited in-date platelet discards from July 2018 to November 2019 to characterize wastage causes. In-date platelet discard data 12 months before and after the start date for each site were analyzed to determine changes in wastage. Of 36 hospital sites, 16 agreed to participate. Pre- and postdiscards were 277 and 301, respectively, for all sites combined. There were no significant before-after change in wastage rate (+0.05%, p = .51). Fifty discards were included in the detailed audit; the most common reasons were return to the blood bank after more than 60 min outside a PTB (n = 17, 34%) and return in a red cell cooler (n = 10, 20%). Implementation of PTB did not improve wastage. Common causes of in-date discards were return after 1 h outside of a PTB and placement in a red cell cooler in error. Further research is required to investigate potential strategies to mitigate in-date platelet wastage.

London 2017: Lessons learned in transfusion emergency planning.

Hospitals prepare for emergencies, but the impact on transfusion staff is rarely discussed. We describe the transfusion response to four major incidents (MIs) during a 6-month period. Three events were due to terrorist attacks, and the fourth was the Grenfell Tower fire. The aim of this paper was to share the practical lessons identified. This was a retrospective review of four MIs in 2017 using patient administration systems, MI documentation and post-incident debriefs. Blood issue, usage and adverse events during the four activation periods were identified using the Laboratory Information Management System (TelePath). Thirty-four patients were admitted (18 P1, 4 P2, 11 P3 and 1 dead). Forty-five blood samples were received: 24 related to nine MI P1 patients. Four P1s received blood components, three with trauma and one with burns, and 35 components were issued. Total components used were six red blood cells (RBC), six fresh frozen plasma (FFP) and two cryoprecipitate pools. Early lessons identified included sample labelling errors (4/24). Errors resolved following the deployment of transfusion staff within the emergency department. Components were over-ordered, leading to time-expiry wastage of platelets. Careful staff management ensured continuity of transfusion services beyond the immediate response period. Debriefing sessions provided staff with support and enabled lessons to be shared. Transfusion teams were involved in repeated incidents. The demand for blood was minimal. Workload was related to sample handling rather than component issue. A shared situational awareness would improve stock management. A laboratory debriefing system offered valuable feedback for service improvement, staff training and support.

Application of blockchain technique to reduce platelet wastage and shortage by forming hospital collaborative networks

Given the short shelf life of blood products and a decrease in donor population, hospitals endeavor to achieve an equilibrium between shortage and outdating. Though collaborating and sharing blood among hospitals will result in a reasonable reduction in surplus and deficit, health regulations strongly discourage blood exchange among hospitals due to traceability issues. With the recent advancement in peer-to-peer networking, blockchains have been used for record transactions in businesses with the advantage of being timestamped. This research is one of the first to address the blood inventory management problem using the blockchain technique by forming a collaborative network of hospitals and exchanging blood in that system, enabling transparency and traceability. A novel clustering technique, called multi-criteria clustering (MCC), using a mixed-integer programming approach, is proposed to form the blockchain network that bases its clustering decisions on a number of conflicting criteria, such as collaboration preference, geographical distribution, hospital size, and operational heterogeneity. Subsequent to this, a mathematical model is developed to identify purchasing strategies for each hospital in a blockchain network, given the opportunity to share blood among other hospitals in that network. This two-phase approach is tested using hospital settings in a neighborhood of a metropolitan city. Sensitivity analysis is performed to evaluate the effectiveness of the blockchain system with respect to change in cost, shelf life, demand distribution, and coefficient of demand variation. Based on the results, it can be concluded that, for all settings, the proposed blockchain network significantly outperforms the current system with independently acting hospitals, in spite of the additional blockchain development and operating expenses that are incurred.

Highly Effective Model for Implementation of In-House Platelets in a Tertiary Veteran Hospital Setting Without a Trauma Center.

Platelet products have a limited shelf life and are costly. Therefore, to balance clinical usage/availability and wastage in a tertiary hospital setting without a trauma center, an innovative system model was established. This system reduced wastage by transferring platelet unit approaching their expiration date to a nearby facility (with the same blood supplier and a trauma center) before expiration, when there is no anticipated need for the product at the original location. A review of data to determine the degree of platelet wastage and wastage costs one year before implementation of this measure in October 2017 and one year after implementation of this measure. Since the implementation of this measure, no platelet units have expired on the shelf. In contrast, from October 2016 to October 2017, before implementation of platelet transfer, platelet products expired regularly. This new system model is highly effective in maintaining platelet inventory without wastage.

Multi-criteria approach for platelet inventory management in hospitals

In this paper, a multiple criteria approach is proposed for platelet inventory management in hospitals. It has been reported that about 20% of the total platelet collected is outdated due to the short shelf life of platelets and demand uncertainty resulting in severe shortage. A multiple criteria mathematical programming (MCMP) model is developed to minimise three criteria: platelet wastage, shortage, and procurement and holding cost. The MCMP problem is solved using three MCMP techniques; preemptive goal programming (PGP), non-preemptive goal programming (NPGP) and weighted objective methods (WOM). A case study is discussed by applying the model to the daily demand data of platelets. Sensitivity analysis is also performed to analyze the impact of goal priorities in the PGP model and weights in the NPGP model and WOM. Based on the policies obtained under PGP, NPGP and WOM methods, the hospital management can decide the most suitable inventory policy for implementation. From the results, it is recommended that preemptive goal programming technique can be used if few goals are extremely important or given very high priority compared to others and is recommended to use weighted moving average or non-preemptive goal programming techniques if equal importance is given to all the goals.

Multi-criteria approach for platelet inventory management in hospitals

In this paper, a multiple criteria approach is proposed for platelet inventory management in hospitals. It has been reported that about 20% of the total platelet collected is outdated due to the short shelf life of platelets and demand uncertainty resulting in severe shortage. A multiple criteria mathematical programming (MCMP) model is developed to minimise three criteria: platelet wastage, shortage, and procurement and holding cost. The MCMP problem is solved using three MCMP techniques; preemptive goal programming (PGP), non-preemptive goal programming (NPGP) and weighted objective methods (WOM). A case study is discussed by applying the model to the daily demand data of platelets. Sensitivity analysis is also performed to analyze the impact of goal priorities in the PGP model and weights in the NPGP model and WOM. Based on the policies obtained under PGP, NPGP and WOM methods, the hospital management can decide the most suitable inventory policy for implementation. From the results, it is recommended that preemptive goal programming technique can be used if few goals are extremely important or given very high priority compared to others and is recommended to use weighted moving average or non-preemptive goal programming techniques if equal importance is given to all the goals.

Highly Effective Model for Implementation of In-House Platelets in a Tertiary Hospital Setting Without a Trauma Center: Corporal Michael J. Crescenz Veterans Affairs Medical Center (CMCVAMC) Experience

Abstract Introduction Platelet products have a limited shelf life and are costly. Hence, it remains crucial to balance clinical usage and wastage in a tertiary hospital setting without a trauma center. Considering this, an innovative system model was established to reduce wastage: the CMCVAMC—starting October 2017—arranged to transfer the platelet unit to a nearby facility with a trauma center when product has a short expiration date and there is no anticipated need for the product. This is a cost-effective measure to reduce platelet wastage and ensure the appropriate blood product availability. Method QA/QI data were reviewed to determine the degree of platelet wastage both a year prior to the implementation of this platelet transfer to another facility and after the past implementation of this transfer to February 2019. The cost of each platelet product was determined from the blood supplier (American Red Cross). From these comparisons prior to and after implementation, a determination of reduction of product wastage and cost savings was made. Results Since the implementation of this platelet transfer, there have been no platelets expiring on the shelf. In contrast, from October 2016 to October 2017 prior to implementation of platelet transfer, platelet products were often wasted or expired. In contrast, from October 2017 to February 2019, there has been no wastage of platelets. Conclusion This is a highly effective model for a tertiary hospital without a trauma center to bring in house platelets without wastage of a costly product while maintaining appropriate availability of the product. This quality improvement system study demonstrates that the measure resulted in significant savings and this serves as a model for other similar facilities. This is an innovative, easy to implement, and cost-effective system model that can be used in other tertiary facilities without a trauma center.

Perishable Inventory Sharing in a Two-Location System

Platelets are critical blood products. The management of platelet inventory is particularly challenging due to its perishable nature with a short shelf-life. Motivated by a platelet inventory management problem at a two-location hospital system, we study how the wastage of platelets, and more broadly perishable products, can be reduced through inventory sharing. In particular, we consider a system with two locations and a single product (e.g., a two-hospital system sharing blood products such as platelets). Each location faces a stochastic demand, and products can be transshipped from one location to the other after demand realization. At each location, products are used to meet demand (or shipped out) in a first-in first-out (FIFO) manner. Although the state of such a complex system consists of the inventory levels of different product ages at both locations, interestingly, we show that the direction of transshipment can be determined by simply comparing the age of the oldest products at each location after meeting demand. Based on this and other structural results, we then prove that a myopic transshipment policy is optimal for a two-period lifetime case and serves as a lower bound on the optimal transshipment quantity for longer lifetimes. Because of its competitive performance and simplicity, a variant of our proposed myopic transshipment policy has been implemented by our partner hospital system, which led to an approximately 20% reduction in platelet outdates.

Platelet ordering policies at hospitals using stochastic integer programming model and heuristic approaches to reduce wastage

Demand uncertainty coupled with a short shelf life of blood platelets has led to a significant wastage at hospitals. An important objective is to minimize wastage of platelets while maintaining a specified service level. To achieve this objective, a mixed integer stochastic programming model under demand uncertainty is developed. Due to the computational complexity of the problem, three heuristic rules are proposed for determining the platelet ordering policy at the hospital. The performance of these three ordering policies is compared against that of the periodic review order-up-to policy proposed in the literature using real-life data obtained from a medical center. The shelf life of arriving platelets, coefficient of variation of demand and cost parameters are varied, and their impact is analyzed on the performance measures and the best rule with respect to each setting is determined. Based on the shelf life setting and cost prioritization, the decision maker can choose the most suitable rule for the hospital.

Audit of Platelet Returns at the Golden Jubilee National Hospital (March 2014-March 2015)

Platelet usage during mechanical circulatory support is well described in the literature. However, there is a limited shelf life on platelets. Platelets were required on site when a patient is placed on mechanical circulatory support. We audited the amount of platelet returns in a tertiary referral center for mechanical circulatory support. The standard for platelet wastage was &lt;12% of platelets used as determined by the excellence criteria by NHS Scotland.