Abstract
A four-pronged approach to improving the blood product delivery system resulted in a significant decrease in the number of blood products ordered STAT, increased ability of the blood bank to fulfill STAT requests in a timely manner, and a significant decrease in the number of blood products outdated and discarded.
BLOOD AND blood products are used every day in almost every hospital in the world. In the United States, approximately 13.9 million units of whole blood and red blood cells (including approximately 695 autologous donations) are transfused to 4.5 million patients every year. This blood is donated by 8 million volunteer blood donors and is collected both by blood centers (93%) and hospital blood donor rooms (7%).1 Less than 5 percent of the eligible population in the United States donates blood each year, and the number of eligible persons donating blood drops to 2 percent in the New York metropolitan area. As additional restrictions and/or testing requirements are mandated in an effort to increase the safety of the blood supply, the percentage of people who are eligible to donate blood decreases. The recently implemented revised criteria for blood donors who have traveled to areas affected by nv Creutzfeldt-Jacob Disease (nvCJD) have the potential to cause a 25 percent decrease in units available for transfusion in the New York area, while, at the same time, the aging population and improved surgical and diagnostic techniques have resulted in an increased demand for blood.2
Blood and blood products are used by a large and diverse patient population, including those patients who have experienced trauma or burns, surgical patients including cardiac and organ transplant patients, and those with chronic anemia due to leukemia and other cancers or to diseases such as sickle cell disease and thalassemia. In 2001, Memorial Hospital for Cancer and Allied Diseases (MHCAD) transfused approximately 17,000 red blood cells and 60,000 units of platelets. MHCAD has an active blood donor room, which performs approximately 12,000 collections per year. Both red blood cells and platelet apheresis products are collected at the hospital. The amount of blood collected in the blood donor room is, clearly, a relatively small percentage of what is necessary for the transfusion support of MHCAD patients. The institution relies on outside sources for the provision of the blood and blood products needed for patient care purposes and currently purchases 13,000 units of red blood cells and 25,000 random unit equivalents of platelets annually.
While blood is not "sold," there are significant costs associated with recruiting and educating donors, collecting, processing (testing for transmissible diseases and preparing components), labeling and storing components, and performing ongoing monitoring activities. Processing fees are charged by the collecting facility to recover the costs, and these fees may vary greatly in different portions of the country. The New York metropolitan area is one of the most expensive.3,4 The health care industry is currently undergoing financial pressures, and as part of the MHCAD community, the blood bank is responsible for using the resource of blood and blood components effectively, efficiently, and with the absolute minimum of wastage. During the ongoing review of systems that is part of the institution's quality program in the blood bank, it was noted that considerable amounts of blood and blood products were outdated because they had been returned unused from the patient care units outside the allowable time frame. These products had to be discarded, at a cost to the institution of $38,000 annually.