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There is an extreme lack of benchmarks out there in the Blood Bank world for us to measure ourselves against. As the other posters above do, I compare to myself and try to show improvements. For example C/T ratio, the historic benchmark is less than 2. But since we are doing primarily electronic crossmatching now and setting up blood "on demand", our goal for C/T is less than 1.5, but we average 1.1, so we will be lowering our goal this year to less than 1.3. % fallouts (transfusions that were given outside our criteria that were not justified): Goal: <2%, last year we were at 0.2% Outdate rate (red cells): Goal: <3%, last year we were at 0.2% Specimen mislabel rate: Goal <1%, last year we were at 0.2% So we will be lowering all of those goals as well. Not too drastically, as Eoin stated, the regulators want to see constant improvement. We are changing our transfusion criteria this year, so our % fallout rate will increase as physicians are going to comply with them "kicking and screaming".

Ditto with David. Most quality indicators in BB cry for 100% compliance (properly labeled specimens, issuing and transfusing right unit to right patient, audits of transfusion process, etc. etc.); you don't need a national consensus to tell you that. A crossmatch/transfusion ratio of 2.0 or less was the benchmark (don't know where that came from) forever, but that can vary a lot with your individual pactices, such as crossmatching units "on call" for OR and inpatients or waiting until blood is actually called for then doing a quick electronic or immediate spin crossmatch. There are some recommendations out there for transfusion triggers for appropriateness review, but those are not always in agreement. We looked at these and reached a consensus between several hospital committees and services (but we didn't agree on all points, either). Sorry if I'm not much help.

We don't use benchmarks (Don't personally know of any published) but we do set targets and try to hit them every year (e.g. 5% reduction in pre-analytical non-conformances; C/T Ratio of 1.2, 10% reduction in wasted units etc), but we have set them for ourselves over the years - Continual improvement is what Joint Commission (and other regulators) loke to see, and they like targets. I think that we have our data analysed to death, Pareto Charts - Tracking & trending, but you can definitely see trends and attack them (reminders about specimen & request completion care and talking to repeat offenders, plus targeted education on any errors that become a trend. We also have a matrix with names down one side and error types across the top. - If there is a horizontal line of numbers of errors against a person, you have a problem person and they can come in for special education sessions - similarly if you have a vertical line of errors , you well could have a system (or process) error. Good luck with it anyway. Cheers W Eoin

Our medical director is over both transfusion services and HPC lab, so if she is notified they have a suspected transfusion reaction to a product (usually a known mismatched product, marrow is the worst culprit with its huge volume/hct), yes, she requests a limited hemolytic workup to be done in transfusion services. It's more of a monitoring panel for severity than a 'find that the patient was misdrawn/wrong armbanded' type of workup. Identity of recipient during a stem cell transplant is so thoroughly monitored backwards and forwards, and they and donors are drawn so many times for ABO confirmation thats never been the source of the problem. Its more frequently something like donor specific proteins in plasma causing hives, or a stronger than normal expected hemolysis to a mismatched product. It's a whole blood product so really any type of reaction can occur. We do purple top for hemolysis/DAT, chemistry tube is sent for LDH/bilirubin/haptoglobin.. i think also bun/crea, urine is sent for positive blood strip/free rbcs present. If they suspect TRALI/TACO they may also request things like chest films, but that is usually initiated in conjunction with the clinical team at bedside. We pull micro cultures at time of issue for fresh products and have a reserved vial of frozen products if microbial contamination is suspected, so that end is usually already covered. I would be very surprised if your center doesnt do these things, it may be coming through a different pathway than your usual, especially if the blood bank is not the first point of contact to notify of problems.