Transfusion QA marker.

Q For years, the benchmark for a quality-assurance (QA) marker in the blood bank has been monitoring the cross-match to transfusion ratio. Since the introduction of the electronic cross-match, this ratio is now meaningless. What has become the marker to review in its absence?

A The writer is correct that with the electronic cross-match, there is no need to monitor the cross-match-to-transfusion (C/T) ratio because it is always the ideal 1.0. There is no replacement marker for the C/T ratio. In fact, there are no required "markers" for blood-bank quality assurance at all--only recommendations in available literature. I have two suggestions to offer for useful quality assurance indicators:

1) If your blood bank is not already monitoring the number of unacceptable samples by source location, this is a good one to measure and report to hospital quality assurance. The cost of sample re-collection should be calculated and reported as well. The cost of re-collecting unacceptable samples reflects wasted real dollars incurred to rectify the non-conforming first sample. For locations that have a high number and cost of unacceptable samples, some process analysis and improvement is indicated.

2) If you use autologous patient blood for transfusion, you might also consider monitoring the numbers and cost of the non-transfused expired units and reporting both the numbers and amounts to the respective medical staff departments (e.g., gynecology, orthopedics). The hospital must pay the blood center for the autologous units collected and received, but the hospital cannot collect for this loss from the patient's payer. Sometimes the information about the cost of waste is enough for the medical staff to be willing to collaborate with the blood-bank medical director in establishing an "autologous blood-collection schedule" analogous to the "surgical blood-order schedules" followed for pre-surgical cross-matching.

--Lucia M. Berte

Quality Systems Consultant

Broomfield, CO