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Blood wastage reduction: a 10-year observational evaluation in a large teaching institution in France
Lana Zoric1, Gerald Daurat, Christophe Demattei
1Anaesthesiology and Critical Care Division, University Carémeau Hospital, Nîmes and Montpellier-Nimes University, Montpellier, France.
Context:
Blood transfusion has increased significantly during the last decade and blood wastage reduction is a medical and economic challenge in hospital practice and for institutional quality, particularly in the ICU and operating theatre.
Objective:
To evaluate the impact of multiple strategies in one hospital to reduce red blood cell wastage.
Design:
Multicentre, prospective, comparative, observational study.
Setting:
Over 10 years, the study was conducted over two time periods. During the first period (2000 to 2003), information was given to medical professionals about blood wastage, and audits (reasons for wastage) were performed, in a large teaching institution (more than 4% wastage in 1999). The second period (2004 to 2010) was designed to analyse the impact of seven strategies intended to minimise blood wastage. Blood wastage reduction in the local centre was compared with regional (64 institutions) and national centres (1470 institutions). Reduction was compared using the Mann-Kendall non-parametric trend test.
Patients:
Local centre (22,572 transfused patients, Nîmes, France), regional centre (South France, 64 institutions, 208,525 transfused patients) and national centres (France, 1470 institutions).
Interventions:
Medical and surgical procedures.
Main Outcome Measures:
The primary end-point was to describe the percentage of blood wastage for two periods in a local centre. The secondary objective was to compare the percentage of blood wastage in the local centre with wastage at regional and national centres.
Results:
Over the 10 year study period the percentage of blood wastage in the local centre decreased, with a significant reduction in the second period, from more than 4% (1999) to less than 1% (2010; P < 0.05). Blood wastage at regional and national centres was never less than 1%. Inadequate containers for transport, absence of a temperature analyser in the ICU and inadequate intraoperative blood strategies (excessive orders of blood) were the main causes of wastage. Correction of these points affected the outcome favourably in the second period, but transfusion information was poor in the first period.
Conclusion:
Seven simple strategies (including transport containers with an effective temperature analyser and audits) decreased blood wastage, especially in the ICU and operating theatre.
