2014-2015 Is the service any good? Determine indications for - PowerPoint PPT Presentation

2014-2015

Is the service any good?

Determine indications for referral Determine times blood referred Identify timescale in which blood was required Are we dealing with requests in a timely manner? How quickly is blood used? Are there different referral/ usage patterns according to urgency? Appropriateness not assessed

“All” urgent or out of hours RCI referrals included Intended for 6 months Paper form completed by RCI, with final outcome collected by RTC administrator

NHSBT number: Patient details Hospital number: Patient Age: Previously known to RCI: Y N Hospital name: Reason for RCI referral: Diagnosis: Hb (g/L): Is the patient bleeding: Y N Is a crossmatch required: Y N Request details How man y units: Any special requirements? Was advice from NHSBT consultant sought: Y N If yes, outcome of advice: Date blood taken: Time blood taken: Time blood arrived at local lab: Time referred to RCI: Urgency: ASAP 1-4 4-8 >8 Tim e left local hospital: Transport mechanism: Time arrived at RCI: Time RCI investigations started: Time RCI result given to requestor: Time blood left issues (if applicable): Timing Transport mechanism: Total time work took: Was blood transfused (if applicable): Y N Transfusion Number of units transfused: If blood not transfused or less than the number of units requested transfused state reason: Time blood transfused (if applicable): Investigation needed and summary of RCI findings: Investigatio Genotype required: Y N Can local lab access results via Sp - ICE: Y N

“All” urgent or out of hours RCI referrals included Intended for 6 months Paper form completed by RCI, with final outcome collected by RTC administrator Started in May 2015, to run for 6 months Not all calls recorded Completed end Feb 2015

78 referrals 37 previously tested in RCI Median age of patient 73.5 (range 4-94) Indications: mostly antibody ID and XM 2 transfusion reaction investigations 6 referrals due to bleeding: 2 maternity, 2 GI bleed, 1 epistaxis and 1 bleeding from stoma

20 18 16 14 12 10 8 6 4 2 0 Cumbria D e e d a s s E K l n i e e Q n t r N d y b s e e a n T l a T T m r a c e S N S u w D d h e n t N u r o S N

AIHA 15 Other haematology 17 Anaemia 13 Surgery 13 Trauma 5 Bleeding 4 Maternity 3 Critical Care 2 Oncology 1 Not stated 5

Referrals by broad clinical category 5, 6% Figures reflect red cell usage patterns 3, 4% 22, 28% 48, 62% Med Surg Obs NK

25 23 Number of referrals 20 18 15 9 10 7 6 6 5 5 3 1 0 40-49 50-59 60-69 70-79 80-89 90-99 100-109 110 and NK over Hb level

38 40 35 30 24 25 20 15 12 10 3 5 1 0 0 2 3 4 6

20, 26% 27, 35% ASAP 1 to 4 hours 4 to 8 hours >8 hours 12, 15% 19, 24%

120 109 100 81 77 76 80 Median Hb, 60 g/L 40 20 0 ASAP 1 to 4 4 to 8 >8 Urgency, hours

30 NK 25 Crit care Surgical 20 Trauma 15 Maternity Bleeding 10 Anaemia 5 Other haem AIHA 0 ASAP 1 to 4 4 to 8 >8

80 67 70 60 50 40 30 20 5 10 3 2 1 0 None Irrad Washed CMV neg NK irrad

Yes No

100% 90% Percentage of samples 5 4 80% 11 9 NK 70% 2 60% NHSBT 2 1 2 50% 2 5 Blood Bike 1 1 40% 5 Lifeline 30% Taxi 5 20% 8 7 8 10% 0% ASAP 1-4 hrs 4-8 hrs >8 hrs Stated urgency

100% 1 1 90% Percentage of referrals 5 2 7 7 80% 70% 4 60% 00.00-08.00 6 50% 20.00-24.00 40% 08.00-20.00 9 19 30% 10 20% 7 10% 0% ASAP 1-4 hrs 4-8 hrs >8hrs Stated urgency

Urgency ASAP 1- 4 hrs 4-8 hrs > 8 hrs Median time, 0 m ins 1 m ins 0 m ins 1 .5 m ins arrival to (up to 4 hrs 10 (up to 1 hr 45 (up to 2 hrs 30 (up to 8 hrs + ) min ) min ) min) investigation start, minutes Time taken from 1 hr 4 5 2 hrs 1 hr 4 5 2 hr 3 0 start of m in m in m in (range 1hr to 3 hrs 50 min ) investigation to (range 1hr to 4 (range 50 min to (range 1 hr to units ready, hours hrs 45 min ) 4 hrs ) 4hrs 30 min ) Time from blood 4 hrs 6 hrs 1 1 hrs 1 4 hrs ready to (range 1 hr 20 (range 2 hrs (range 4 hrs to (range 8 hrs to to 84 hrs ?? ) 15 min to 9 24 hrs) 40 hrs ) transfusion, hours hrs 30 min)

Panreactive auto + / - others 25 Multiple alloantibodies 12 Single antibodies 8 Cold antibodies 5 “AB ID and XM” 4 Nil found 10 Weak non-specific 4 NK/ not clear 10

Panreactive 17 Allo anti E 6 Allo anti e 5 Auto-c, allo K, Auto cold antibodies 5 Allo-e, allo Jka, allo-C, weak non-specific 4 Kpa 3 Fya, M, auto-C 2 Cw, D, BgA, Ce, S 1 Nothing 9 Weak, non-specific, B* * * * d 4 Other 8 Not stated 10

100% Percentage of orders sent 4 6 NK 4 80% N/A 10 2 3 1 Taxi 60% 1 Routine 4 7 1 2 NHSBT 1 40% 2 Lifeline 4 5 2 2 Blue Light 20% 1 4 1 1 Blood bike 2 1 1 2 1 1 0% Collect ASAP 1-4 hrs 4-8 hrs >8 hrs Ad hoc Stated urgency

100% 1 1 90% Percentage of referrals 6 6 2 80% 9 70% 60% Other 50% No 40% Yes 9 14 13 17 30% 20% 10% 0% ASAP 1-4 hrs 4-8 hrs >8hrs Stated urgency Other: 1 not known. 1 an ATR investigation

16 not required 1 “own units” 1 patient died 5 Not known

41% of referrals state blood needed within 4 hours Majority of referrals related to medical rather than surgical indication AIHA Other haematology problem Urgency not relelated to Hb Different immediate indications for urgent and less urgent samples Very prompt response when sample arrives!! Time from blood being available to being transfused is related to stated urgency Commonest problem is panreactive antibody/ auto

None from me Any thoughts? And thank you!