One-year retrospective analysis of red cell concentrate requisition and utilization practices at Regional and District hospitals with no blood bank on-site, Metro West Cape Town, South Africa: A multicentre descriptive study

Chiu, Chian-Jia

One-year retrospective analysis of red cell concentrate requisition and utilization practices at Regional and District hospitals with no blood bank on-site, Metro West Cape Town, South Africa: A multicentre descriptive study

Thesis / Dissertation

2023

Abstract

Introduction: The usage of red cell concentrate (RCC) is an essential part of patient blood management (PBM). While a substantial amount of literature describes RCC usage at tertiary institutions, very few exists in the setting of regional or district hospitals with no blood bank on-site (H-NBBOS). Addressing this shortfall in countries with a strained health economy, such as South Africa, is imperative. This scarcity of resources also renders the intervention studies needed to improve blood utilisation and PBM particularly difficult. Material and Methods: A 12-month retrospective and comparative study investigating RCC usage across a hospital with a blood bank on-site (H-BBOS) or H-NBBOS and the various specialities, in Metro West Cape Town, South Africa. We proposed a set of new blood utilisation indices: individualised crossmatch-to-transfusion ratio (iCTR) and individualised transfusion-to-crossmatch ratio (iTCR), over and above conventional indices, to comprehensively ascertain the efficiency of both RCC crossmatching and transfusion practices through individualised cases. Regression analyses were performed to provide recommendations for a cost-effective intervention study to improve future PBM. Results: Apart from wastage ratio (3.74%) of H-NBBOS, all other overall blood utilisation indices for both H-BBOS and H-NBBOS were in accordance with international benchmarks. The overall crossmatch-to-transfusion ratio (CTR) of 1.19 in H-NBBOS indicated greater crossmatching efficiency than the H-BBOS (1.31). The superior efficiency of H-NBBOS was substantiated via statistical inference of our proposed individualised patient indices of iCTR and iTCR (p<0.05). Regression analyses of the various specialities revealed that Surgery and Obstetrics/Gynaecology of both H-NBBOS and the H-BBOS had the least efficient blood utilisation practices and higher chances of wastage. Conclusions: The conventional overall CTR showed that H-NBBOS were considerably more efficient than the H-BBOS. However, only a marginal difference was detected through the analysis of our proposed iCTR (p<0.05). There was a more distinctive difference in transfusion practices, with H-NBBOS transfusing proportionately more than the BBOS hospital. This advocates the importance of also investigating the utilisation efficiency from a transfusion perspective. A cost-effective intervention study focused on Surgery and Obstetrics/Gynaecology departments, particularly in H-NBBOS, is recommended to improve future blood utilisation practices in South Africa. In addition, our proposed indices enabled comprehensible and insightful interrogation of both crossmatching and transfusing practices. The individualisation of efficiency indices also permitted further objective statistical inferences. Therefore, we propose the incorporation of these indices in future blood utilisation analyses.

Keywords

Anaesthesia and Perioperative Medicine

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