Developing clinical performance indicators for pre‐hospital blood transfusion: The Thames Valley Air Ambulance approach

Abstract

Objective: In this article, we describe how we developed and validated key performance indicators (KPIs) for pre-hospital blood transfusion and offer suggestions for other organisations wishing to develop performance metrics.Background: KPIs are metrics that compare actual care against an ideal structure, process or outcome standard. An increasing number of UK-based pre-hospital critical care services now carry blood components to enable pre-hospital blood transfusion.Methods: A working group of pre-hospital physicians and paramedics was formed to create and validate performance indicators that reflected a high-quality pre-hospital transfusion. This was performed by literature searching and reviewing consensus documents that guide the best practice and then adjusting the indicators as the process evolved. Results: Throughout the year, the performance against the domains was monitored monthly and outputs communicated within the clinical staff of the organisation; at the end of the year, the domains were amended. The final list of performance indicators was as follows: (a) rationale for transfusion documented in the notes; (b) rationale for transfusion in line with Thames Valley Air Ambulance blood transfusion guideline; (c) aggressive management of hypothermia; (d) tranexamic acid administered within an hour of injury; (e) evidence of bleeding in hospital; (f) monitoring of adverse effects of blood transfusion; (g) overall-was the use of blood justified; and (h) no units wasted this month. Conclusions:This study has shown that it is feasible to devise and implement clinical performance indicators for pre-hospital blood transfusion and that their use has increased the focus on this important area.

Current state of technical transfusion medicine practice for out‐of‐hospital blood transfusion in Canada

“…Regarding the blood component use by OHBTPs around the world, London's Air Ambulance Charity in the United Kingdom, with the initiative ‘Blood on Board’, reported carrying group O negative RBC units [25] and demonstrated that the use of O negative RBC units in the out‐of‐hospital setting did not change the proportion of group O negative RBCs transfused overall. The Thames Valley Air Ambulance, a UK‐based Air Ambulance organization, carries 2 units of O negative and K negative RBC units and 2 units of thawed blood group A plasma [26], similar to other UK OHBTPs and the BCEHS programme. The Norwegian helicopter emergency medical services (EMSs) implemented an OHBTP with freeze‐dried plasma in 2013 and then transitioned to low‐titre cold‐stored whole blood in 2015, no longer carrying RBC units [27].…”

“…The availability of 4 units of RBC units per box is typically more than that stored in coolers used in Canada. This cooler is validated to keep a steady-state temperature of 2-4 C for up to 72 h. The Thames Valley Air Ambulance is using an insulated Credo Cube cooler (Peli BioThermal, Maple Grove, Minnesota, USA) with a temperature logger contained in the box [26].…”

Prehospital administration of blood and plasma products

“…In civilian prehospital trauma studies, the injury severity score (ISS) varied, as the diagnostic accuracy differed widely from 44.5% to 90%, even among specially trained medical staff [16]. The frequency of prehospital transfusion of pRBCs differed substantially, ranging from 0.5% of trauma patients up to 5% in this population [3,5,7,11,14,17]. In their retrospective analysis, Rehn et al reported a significant reduction in prehospital mortality in patients treated with 2-4 U of pRBCs [7].…”