Allocating blood to hospitals.

A method is proposed for the allocation of units of blood from a regional blood transfusion centre to the hospitals of its area, taking into consideration the characteristics of the individual hospitals, such as the transfusion activity, the demand of each hospital and the regional blood transfusion service policy concerning the allocation of units of blood expressed through a utility function. The problem is formulated as a stochastic programming problem but reduces to a linear programming problem and therefore is easily applicable. The method is suitable for application in systems with a National Health Service system, such as the British. Finally the results are given of an application to the despatches of units of blood in the Regional Blood Transfusion Service of Glasgow and West of Scotland.

Organisational management of hospital blood transfusion services in Nairobi County, Kenya: Evidence of implementation

Background: The World Health Organization in 2002 recommended implementation of a quality system for national blood programmes to ensure adequate and safe blood products to patients. Key elements of the quality system include organisational management, standards, documentation, training and assessment.Objectives: The aim of this study was to describe the extent to which organisational management, which is the first element of a quality system, has been implemented in hospitals in Nairobi County, Kenya.Methods: A descriptive, cross-sectional study design was used. Sixty health workers were selected as respondents from 15 hospitals that provide blood transfusion services in Nairobi County. The data collection period was from June to August 2015 and the data were analysed in 2016.Results: Faith-based hospitals had the lowest level of organisational management implementation (33.3%), private hospitals had 42.5%, whereas government hospitals had the highest implementation (60%). The extent of implementation was based on performance of the senior management team, overall rated by the respondents at 40.1%, establishment of hospital transfusion committees in nine (60%) of the hospitals and appointment of key staff ­ quality officers in three (20%) hospitals and blood transfusion specialists in six (40%) hospitals. These key staff were instrumental in steering the quality system and ensuring sound blood transfusion practices.Conclusion: The implementation of quality management systems in hospital blood transfusion services can be improved through commitment from senior management teams, who should provide the necessary resources for employment of key staff and establish and empower hospital transfusion committees to guide the blood transfusion services

An analysis of surgical blood use in United States hospitals with application to the maximum surgical blood order schedule.

Excessive preoperative crossmatching can be limited with a maximum surgical blood order schedule (MSBOS) which is a list of the commonly performed elective surgical procedures performed in a hospital with the maximum number of units of blood which will be crossmatched preoperatively for each. The purpose of this study was to analyze the blood requirements of 535,031 surgical patients treated in 300 United States hospitals during 1974, and to suggest maximum preoperative blood orders including type and screen recommendations based on data derived from this large national patient sample. Such recommendations are offered for 63 common elective surgical procedures. Specific reference is made to blood utilization during hysterectomy, transurethral resection of the prostate, and cesarean section. A preoperative type and screen order is adequate for the vast majority of patients undergoing these latter procedures.

Home transfusion therapy: a new dimension in home care.

Visiting Nurse Service, Inc (VNS), of Akron, Ohio, has provided transfusion therapy in the home since January 1984. Home transfusion has proved a valuable alternative to inpatient treatment and to expensive, exhausting ambulance trips to the hospital for outpatient treatment for selected homebound patients, many of whom are terminally ill. The VNS program is based on detailed policies and procedures that include patient referral criteria, RN education, patient education, blood procurement and labelling, and protocols for transfusion complications. Recognizing the need for patient safety, VNS has a quality assurance program that provides for continuous monitoring and evaluation of the home transfusion therapy, especially of any adverse reactions that occur.

Simulation analysis of platelet production and inventory management.

To maximize the availability of platelet concentrates (PC) and minimize their outdate, competing criteria, a computer simulation model of platelet production and distribution was developed. Based on 2 years of actual platelet orders placed with a regional blood center, the simulation program generated daily platelet orders, and also calculated mean demand and standard deviation of demand for each day of the week. The number of PC to be produced on a given day was calculated from: PC to be produced = (mean demand for that day of the week) + Tx (standard deviation of demand for that day of the week)-(PC in inventory on the given day), where T is a selected multiple of the standard deviation. As T increases, availability is maximized, but outdating is expected to increase. Conversely, lower T is associated with less availability, but lower outdate. At the simulated platelet demand level (about 735 PC per week), with 3-day platelet storage life, 99% availability is associated with 1% outdate and distribution of PC of less than 1 day average age. 100% availability, with no outdate is predicted for a 5-day storage life, with no further improvement in logistics with 7-day storage life, at this level of demand. Although logistics of platelet production and distribution vary from center to center, the simulation analysis is generally applicable, and a formal plan has the great advantage of predictive, rather than reactive, platelet production.

Maternal mortality in Riyadh, Saudi Arabia.

The maternal mortality in the Maternity and Children Hospital, Riyadh, during the years 1978-1980 was 52 per 100 000 births, when the total births were 55 428. This is higher than the rate reported from the hospitals in developed countries but lower than rates reported by the university hospitals of developing countries such as India, Thailand and Nigeria. Haemorrhage, associated disease, pulmonary embolism and infection, in that order, were the main causes of maternal deaths. The main avoidable factor was failure by the patient to seek the medical care. Much could be done in reducing deaths due to haemorrhage by improving blood transfusion facilities in the peripheral hospitals. Adequate health education, especially of rural women and their midwives, is a crucial factor in improving the maternal death rate for the country as a whole.

PIP: The maternal mortaltiy in the Maternity and Children Hospital, Riyadh, during the period 1978-80 was 52/100,000 births and total births were 55,428. This is higher than the rate reported from hosptials in developed countries but lower than rates reported by the university hospitals of developing countries such as India, Thailand, and Nigeria. Hemorrhage, associated disease, pulmonary embolism, and infection, in that order, were the main causes of maternal death. The main avoidable factor was failure by the patient to seek medical care. Much could be done to reduce deaths due to hemorrhage by improving blood transfusion facilities in the peripheral hospitals. Adequate health education, especially of rural women and their midwives, is a crucial factor in improving the maternal death rate for the country as a whole.

Blood and component wastage report. A quality assurance function of the hospital transfusion committee.

The transfusion service of a regional referral medical center issues a monthly blood and component wastage report to the Hospital Transfusion Committee. The report includes the amount and type of units wasted, who is responsible, and the cost incurred by the wastage. The individuals responsible for wastage include physicians, nurses, and laboratory personnel. Physicians are responsible for most wastage, principally by failing to administer thawed or pooled blood products. The Hospital Transfusion Committee initiated a wastage-reduction program that included a letter to physicians indicating the patient's name and the type of blood and/or components that the addressed physicians was responsible for wasting. Simple corrective actions results in a 73 percent reduction in our blood and component wastage. Monitoring of blood and component wastage should be routine quality assurance function of the Hospital Transfusion Committee.

Some aspects of blood transfusion practice in West Africa

It is agreed that safe blood transfusion is achieved only through the joint implementation of safe donation; quality in testing and processing and transfusion only when essential. The article throws light on current transfusion practice in West Africa and suggests ways to implement the above three components which together make blood transfusion safe