RL0121 Posted January 30, 2012 Share Posted January 30, 2012 I hate to post this question but its bugging me for the last 2 weeks In my monthly usage report, I have to calculate % RBC utilization. I look at our existing policy which was originally written in 1992 and was revised in 2004. According to the policy; % utilization of RBC is calculated by dividing the number of RBC transfused for the month by the number of RBC transfused. The total should be 100%.That don't make any sense to me. If we transfused 263 and wasted 6 for the month, I guess my calculation should be 263/269 X100=97.77%. The policy should say; % utilization of RBC is calculated by dividing the total number of RBC transfused for the month by the number of RBC transfused + total number of wasted RBC x 100.Inputs are greatly appreciated. Thank you. Link to comment Share on other sites More sharing options...
David Saikin Posted January 30, 2012 Share Posted January 30, 2012 If that is how you want to define it, it is your perogative. We just calculate the C:T ratio, we do that in toto, by service and by MD. Outdated/wasted products get their own segment of my report. Link to comment Share on other sites More sharing options...
Brenda K Hutson Posted January 30, 2012 Share Posted January 30, 2012 Right; I think what you are actually looking for is the C:T Ratio; the number of Crossmatches Ordered to the number of Transfusions. "Ideally" (though I have not seen it anywhere), it would be 1:1.Brenda Hutson Link to comment Share on other sites More sharing options...
Dr. Pepper Posted January 30, 2012 Share Posted January 30, 2012 We do it the same as David. 2.0 is a commonly accepted benchmark for C/T ratio, but most places are lower than that. The more comfortable the docs are with just a type and screen, knowing that you can get units out the door in just a minute or two with an electronic or immediate spin crossmatch, the less "unused" crossmatches you'll have. "On call" catagories for surgical and medical patients are the things that drive the ratio up. Link to comment Share on other sites More sharing options...
tbostock Posted January 30, 2012 Share Posted January 30, 2012 Yes, I agree it's probably the C/T ratio that best captures utilization. We also do stats on appropriate usage; we calculate the number of transfusions that "fell out" of our transfusion criteria divided by the total number of units transfused for the month. Link to comment Share on other sites More sharing options...
L106 Posted January 30, 2012 Share Posted January 30, 2012 I agree with the previous several posters regarding the Crossmatch:Transfusion Ratio. However, documenting blood wastage is also important. You could make this part of your monthly report as the "% of units wasted", or you could report it as the amount of financial loss to the institution for that month. Link to comment Share on other sites More sharing options...
Marilyn Plett Posted January 30, 2012 Share Posted January 30, 2012 I like the idea of reporting both the units wasted and the financial loss. In my experience, doctors and nurses are clueless about the cost of blood products (not to mention infusion sets, etc.). And they are the people who can really impact your numbers. Link to comment Share on other sites More sharing options...
RL0121 Posted January 31, 2012 Author Share Posted January 31, 2012 Thanks for the input folks. C/T ratio is included in our monthly report but I think I will revised the policy and will include RBC wastage. 100% RBC utilization is ideal but our current policy don't reflect the wastage portion. Link to comment Share on other sites More sharing options...
Liz Posted February 14, 2012 Share Posted February 14, 2012 I would be interested in knowing if anyone else does the CT ratio like Dave mentioned: "by service and by MD". We get good numbers and the Blood Utilization committee said this was thanks to the Internal Medicine Oncologists who keep it balanced. I broke it down and indeed surgery was high and balanced out by Medicine. But by MD, that would take a lot of time. Link to comment Share on other sites More sharing options...
Deny Morlino Posted February 14, 2012 Share Posted February 14, 2012 We do not at this point. It would take a bit of time, but may be worth the effort if a particular subgroup of physicians tend to over order on a regular basis. It would be "evidence" of the need to utilize evidence based decisions instead of a knee-jerk reflex order. I think I will add it to my list to consider as a trial to see where different specialities are falling in comparison to each other. Link to comment Share on other sites More sharing options...
Auntie-D Posted February 14, 2012 Share Posted February 14, 2012 Deny - we do this. Our blood usage figures were rubbish - about 60% of units cross matched were transfused. When we separated this by area it turned out that maternity had a 3% usage rate! They have this habit of requesting 4 units automatically on every patient that bleeds, regardless of risk. When our haematologist had spoke to them they had more confidence in our ability to get them blood quickly and our usage has risen to 93% Link to comment Share on other sites More sharing options...
Deny Morlino Posted February 14, 2012 Share Posted February 14, 2012 That is an impressive change and encouraging at the same time. Thanks for the information. Link to comment Share on other sites More sharing options...
Auntie-D Posted February 15, 2012 Share Posted February 15, 2012 Deny-Ive found eduction increases their confidence in us and in turn a) reduces the number of 'just in case' crossmatches and they order minimal amounts, knowing if they need more we can get it to them pretty quickly.We also do not refuse one unit crossmatches as we transfuse to symptoms rather than numbers. A little old lady who weighs 6 stone wet is highly unlikely to need 3, or even 2 units, so we are happy to issue one. Our consultants are good as well in that if 3 units have been requested but the patients symptoms disappear after one unit they will stop transfusing (this does effect our %usage though).I would like to add as well we are a small hospital with limited high risk surgical procedures so our 93% may be a little biased Link to comment Share on other sites More sharing options...
Deny Morlino Posted February 15, 2012 Share Posted February 15, 2012 Sounds like we are of a similar size and demographic so the 93% might not be too far fetched for us. A primary goal this year for us is to push for more evidence based transfusions and alternatives to transfusion. AABB has a series of webinars this year related to this thought process. It will ultimately come down to our pathologist educating the physicians on changes to produce the desired effect. I agree with the patient size and unit necessary relationship you expressed as well. Still have a handful of older physicians that over transfuse a bit that will need some coaching. Link to comment Share on other sites More sharing options...
tbostock Posted February 15, 2012 Share Posted February 15, 2012 We improved our C/T ratio to 1.1 when we stopped having physicians ordering crossmatches. Now they just order the Type and Screen and when they are ready to transfuse, they order the blood product. We then crossmatch the number of units that he/she ordered based on the type of crossmatch that this patient requires (electronic, IS, or IgG). If a patient has a clinically significant alloantibody, we find antigen negative units and put 2 on hold for the patient; on OR day when we get the Type and Screen they are ready to go. Link to comment Share on other sites More sharing options...
Deny Morlino Posted February 15, 2012 Share Posted February 15, 2012 I like the sound of this process!! A goal to work toward. Our average over 2011 was 1.23 so there is room for improvement. Link to comment Share on other sites More sharing options...
Mabel Adams Posted February 17, 2012 Share Posted February 17, 2012 I don't think we should expect the same utilization from oncology as we do cardiac surgeons. I keep wondering whether to ditch the CT ratio entirely but maybe we just need to tighten it down close to 1 as some of you have or define it separately for different services. It was established that it should be less than 2 back in the day when everyone got AHG xms doing 30 min. albumin incubations and you worked up all the cold antibodies cuz you did a room temp antibody screen too. I can't imagine that 2 is still a reasonable number at all unless you just want to have a benchmark that you can always be successful at meeting. Link to comment Share on other sites More sharing options...
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