There is substantial geographic variation in the use of breast-conserving surgery, which cannot be explained by differences in hospital characteristics. Hospital characteristics that were independently redictive of greater use of breast-conserving surgery were the size of the metropolitan area, the status of the institution as a teaching hospital, and the availability of radiation therapy and geriatric services.
Using data collected by an automated blood inventory and information system, an in‐depth description of the functioning of a 31‐hospital regional blood bank system for a 10‐month period is presented. A total of 43,514 units of blood were included in this analysis. The following factors which affect the blood distribution process were studied: (1) recycling of blood units; (2) blood types; and (3) hospital inventory levels.
It was found that blood recycling allows management flexibility and apparently is important in reducing blood outdating. It was shown that rare blood types are utilized differently from other types and consequently require special management practices for effective use. Ordering and recycling in the system differed greatly from hospital to hospital. The ratio of average daily inventory/average daily transfusions, was used to evaluate efficiency of hospital blood banks. In addition to analyzing those factors associated with the blood distribution process in a regional system, this study demonstrated types of information that can be derived from an automated data acquisition system.
The practice of allowing participating hospitals in a regional blood bank system to return unneeded blood units to the central bank for redistribution (recycling) makes it difficult to account for each hospital's role in the production of outdates. The usual blood management efficiency criterion of measuring the rate of outdating occurring at a particular hospital has limited meaning when there is recycling because some hospitals avoid high outdate rates by “dumping” their old units on the central bank, while other hospitals have high outdate rates, because they receive disproportionately large numbers of old blood units which have been returned by other hospitals. By using data from a one‐year period at Milwaukee Blood Center, a new blood management efficiency criterion, effective outdate rate, is derived with the use of basic Markovian principles. This is the rate at which a hospital contributes to outdates anywhere in the regional system. The rate for each hospital may be compared to evaluate the relative performance of that hospital. The rate is also converted to a “cost of transfusion” to give a direct “dollar” method for informing hospital blood bank managers of their performance.
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