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: Hospital number: Patient Age: Previously known to RCI: Y N Patient details Hospital name: Reason for RCI referral: Diagnosis: Hb (g/L): Is the patient bleeding: Y N Is a crossmatch required: Y N How many units: Any special requirements? Was advice from NHSBT consultant sought: Y N Request details 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 Time 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): Transport mechanism: Timing Total time work took: Was blood transfused (if applicable): Y N Number of units transfused: If blood not transfused or less than the number of units requested transfused state reason: Transfusion Time blood transfused (if applicable): Investigation needed and summary of RCI findings: Genotype required: Y N Investigatio 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

• utcome 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

2 4 6 8 10 12 14 16 18 20

Cumbria D a n d D N e w c a s t l e N T e e s S T e e s Q E S T y n e S u n d e r l a n d N

• r

t h u m b r i a N K

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

48, 62% 22, 28% 3, 4% 5, 6% Med Surg Obs NK

Figures reflect red cell usage patterns

1 5 9 23 7 3 6 6 18

5 10 15 20 25

40-49 50-59 60-69 70-79 80-89 90-99 100-109 110 and

• ver

NK

Hb level Number of referrals

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

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

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

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

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

Yes No

8 5 7 8 1 1 5 5 2 2 2 2 1 9 4 5 11

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

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

1 4 hrs

(range 8 hrs to 40 hrs )

1 1 hrs

(range 4 hrs to 24 hrs)

6 hrs

(range 2 hrs 15 min to 9 hrs 30 min)

4 hrs

(range 1 hr 20 to 84 hrs ?? )

Time from blood ready to transfusion, hours

2 hr 3 0 m in

(range 1 hr to 4hrs 30 min )

1 hr 4 5 m in

(range 50 min to 4 hrs )

2 hrs

(range 1hr to 3 hrs 50 min )

1 hr 4 5 m in

(range 1hr to 4 hrs 45 min )

Time taken from start of investigation to units ready, hours

1 .5 m ins

(up to 8 hrs + )

0 m ins

(up to 2 hrs 30 min)

1 m ins

(up to 1 hr 45 min )

0 m ins

(up to 4 hrs 10 min )

Median time, arrival to investigation start, minutes

> 8 hrs 4-8 hrs 1- 4 hrs ASAP Urgency

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

2 2 1 1 1 1 1 1 1 2 2 5 4 2 4 4 1 7 1 2 3 1 1 2 10 4 4 6

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

14 9 13 17 6 2 6 9 1 1 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% ASAP 1-4 hrs 4-8 hrs >8hrs Stated urgency Percentage of referrals Other No Yes

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!