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Balkhi B, Alshahrani A, Khan A. Just-in-time approach in healthcare inventory management: Does it really work? Saudi Pharm J 2022; 30:1830-1835. [PMID: 36601508 PMCID: PMC9805965 DOI: 10.1016/j.jsps.2022.10.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2022] [Accepted: 10/31/2022] [Indexed: 11/05/2022] Open
Abstract
Healthcare organizations need to efficiently use their available resources, improve their productivity, reduce operating costs, and provide high-quality services. Just in time (JIT) is an approach that has benefited the healthcare industry in these regards, improving patient outcomes by reducing waste and non-value-adding activities. As such, our main purpose in this study was to discuss the use of JIT systems in healthcare inventory management and highlight their importance, as well as explore the advantages and limitations of JIT systems in healthcare management systems. We also explored supply chain issues in healthcare during the COVID-19 pandemic and provide strategies and recommendations for improvement.
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Affiliation(s)
- Bandar Balkhi
- Clinical pharmacy Department, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia,Pharmacoeconomic Unit, Pharmaceutical Care Service Administration, Armed Forces Hospital - Southern Region (AFHSR), Khamis Mushait, Saudi Arabia,Corresponding author at: College of Pharmacy, King Saud University, P. O. Box 2457, Riyadh 11451, Saudi Arabia.
| | - Abdullah Alshahrani
- Pharmacoeconomic Unit, Pharmaceutical Care Service Administration, Armed Forces Hospital - Southern Region (AFHSR), Khamis Mushait, Saudi Arabia
| | - Anas Khan
- Department of Emergency Medicine, College of Medicine, King Saud University, Riyadh, Saudi Arabia,Global Center for Mass Gathering Medicine, Ministry of Health, Saudi Arabia
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2
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Khalil M, Ravaghi H, Samhouri D, Abo J, Ali A, Sakr H, Camacho A. What is "hospital resilience"? A scoping review on conceptualization, operationalization, and evaluation. Front Public Health 2022; 10:1009400. [PMID: 36311596 PMCID: PMC9614418 DOI: 10.3389/fpubh.2022.1009400] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Accepted: 09/27/2022] [Indexed: 01/27/2023] Open
Abstract
Background COVID-19 underscored the importance of building resilient health systems and hospitals. Nevertheless, evidence on hospital resilience is limited without consensus on the concept, its application, or measurement, with practical guidance needed for action at the facility-level. Aim This study establishes a baseline for understanding hospital resilience, exploring its 1) conceptualization, 2) operationalization, and 3) evaluation in the empirical literature. Methods Following Arksey and O'Malley's model, a scoping review was conducted, and a total of 38 articles were included for final extraction. Findings and discussion In this review, hospital resilience is conceptualized by its components, capacities, and outcomes. The interdependence of six components (1) space, 2) stuff, 3) staff, 4) systems, 5) strategies, and 6) services) influences hospital resilience. Resilient hospitals must absorb, adapt, transform, and learn, utilizing all these capacities, sometimes simultaneously, through prevention, preparedness, response, and recovery, within a risk-informed and all-hazard approach. These capacities are not static but rather are dynamic and should improve continuously occur over time. Strengthening hospital resilience requires both hard and soft resilience. Hard resilience encompasses the structural (or constructive) and non-structural (infrastructural) aspects, along with agility to rearrange the space while hospital's soft resilience requires resilient staff, finance, logistics, and supply chains (stuff), strategies and systems (leadership and coordination, community engagement, along with communication, information, and learning systems). This ultimately results in hospitals maintaining their function and providing quality and continuous critical, life-saving, and essential services, amidst crises, while leaving no one behind. Strengthening hospital resilience is interlinked with improving health systems and community resilience, and ultimately contributes to advancing universal health coverage, health equity, and global health security. The nuances and divergences in conceptualization impact how hospital resilience is applied and measured. Operationalization and evaluation strategies and frameworks must factor hospitals' evolving capacities and varying risks during both routine and emergency times, especially in resource-restrained and emergency-prone settings. Conclusion Strengthening hospital resilience requires consensus regarding its conceptualization to inform a roadmap for operationalization and evaluation and guide meaningful and effective action at facility and country level. Further qualitative and quantitative research is needed for the operationalization and evaluation of hospital resilience comprehensively and pragmatically, especially in fragile and resource-restrained contexts.
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Affiliation(s)
- Merette Khalil
- Department for Universal Health Coverage and Health Systems, World Health Organization Regional Office for the Eastern Mediterranean, Cairo, Egypt,*Correspondence: Merette Khalil
| | - Hamid Ravaghi
- Department for Universal Health Coverage and Health Systems, World Health Organization Regional Office for the Eastern Mediterranean, Cairo, Egypt
| | - Dalia Samhouri
- Health Emergencies Programme, World Health Organization, Regional Office for the Eastern Mediterranean, Cairo, Egypt
| | - John Abo
- Asian Disaster Preparedness Center, Bangkok, Thailand
| | - Ahmed Ali
- Health Emergencies Programme, World Health Organization, Regional Office for the Eastern Mediterranean, Cairo, Egypt
| | - Hala Sakr
- Department of Healthier Populations, World Health Organization, Regional Office for the Eastern Mediterranean, Cairo, Egypt
| | - Alex Camacho
- Health Emergencies Programme, World Health Organization, Regional Office for the Americas, Washington, DC, United States
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3
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Stanworth SJ, Dowling K, Curry N, Doughty H, Hunt BJ, Fraser L, Narayan S, Smith J, Sullivan I, Green L. A guideline for the haematological management of major haemorrhage: a British Society for Haematology Guideline. Br J Haematol 2022; 198:654-667. [PMID: 35687716 DOI: 10.1111/bjh.18275] [Citation(s) in RCA: 30] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Revised: 05/07/2022] [Accepted: 05/09/2022] [Indexed: 12/17/2022]
Affiliation(s)
- Simon J Stanworth
- Transfusion Medicine, NHS Blood and Transplant, Oxford, UK.,Department of Haematology, Oxford University Hospitals NHS Foundation Trust, Oxford, UK.,Radcliffe Department of Medicine, University of Oxford, and NIHR Oxford Biomedical Research Centre, Oxford, UK
| | - Kerry Dowling
- Transfusion Laboratory Manager, Southampton University Hospitals NHS Foundation Trust, Southampton, UK
| | - Nikki Curry
- Department of Haematology, Oxford University Hospitals NHS Foundation Trust, Oxford, UK.,Radcliffe Department of Medicine, University of Oxford, and NIHR Oxford Biomedical Research Centre, Oxford, UK
| | - Heidi Doughty
- Institute of Inflammation and Ageing, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK.,NIHR Surgical Reconstruction and Microbiology Research Centre, Birmingham, UK
| | - Beverley J Hunt
- Department of Haematology, Guy's and St Thomas's Hospital, London, UK
| | - Laura Fraser
- Transfusion Practitioner, NHS Lanarkshire, University Hospital Wishaw, Wishaw, UK.,National Services Scotland/Scottish National Blood Transfusion, Edinburgh, UK
| | - Shruthi Narayan
- Medical director, Serious Hazards of Transfusion, Manchester, UK
| | - Juliet Smith
- Lead Transfusion Practitioner, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Ian Sullivan
- Transfusion Laboratory Manager, Royal Cornwall Hospitals NHS Trust, Truro, UK
| | - Laura Green
- Transfusion Medicine, NHS Blood and Transplant, London, UK.,Barts Health NHS Trust, London, UK.,Blizzard Institute, Queen Mary University of London, London, UK
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4
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Tallach R, Schyma B, Robinson M, O'Neill B, Edmonds N, Bird R, Sibley M, Leitch A, Cross S, Green L, Weaver A, McLean N, Cemlyn-Jones R, Menon R, Edwards D, Cole E. Refining mass casualty plans with simulation-based iterative learning. Br J Anaesth 2021; 128:e180-e189. [PMID: 34753594 DOI: 10.1016/j.bja.2021.10.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Revised: 10/08/2021] [Accepted: 10/09/2021] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Preparatory, written plans for mass casualty incidents are designed to help hospitals deliver an effective response. However, addressing the frequently observed mismatch between planning and delivery of effective responses to mass casualty incidents is a key challenge. We aimed to use simulation-based iterative learning to bridge this gap. METHODS We used Normalisation Process Theory as the framework for iterative learning from mass casualty incident simulations. Five small-scale 'focused response' simulations generated learning points that were fed into two large-scale whole-hospital response simulations. Debrief notes were used to improve the written plans iteratively. Anonymised individual online staff surveys tracked learning. The primary outcome was system safety and latent errors identified from group debriefs. The secondary outcomes were the proportion of completed surveys, confirmation of reporting location, and respective roles for mass casualty incidents. RESULTS Seven simulation exercises involving more than 700 staff and multidisciplinary responses were completed with debriefs. Usual emergency care was not affected by simulations. Each simulation identified latent errors and system safety issues, including overly complex processes, utilisation of space, and the need for clarifying roles. After the second whole hospital simulation, participants were more likely to return completed surveys (odds ratio=2.7; 95% confidence interval [CI], 1.7-4.3). Repeated exercises resulted in respondents being more likely to know where to report (odds ratio=4.3; 95% CI, 2.5-7.3) and their respective roles (odds ratio=3.7; 95% CI, 2.2-6.1) after a simulated mass casualty incident was declared. CONCLUSION Simulation exercises are a useful tool to improve mass casualty incident plans iteratively and continuously through hospital-wide engagement of staff.
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Affiliation(s)
- Rosel Tallach
- Royal London Hospital, London, UK; Raigmore Hospital, Inverness, UK.
| | - Barry Schyma
- Royal London Hospital, London, UK; Royal Infirmary of Edinburgh, Edinburgh, UK
| | - Michael Robinson
- Royal London Hospital, London, UK; Royal Free Hospital, London, UK
| | | | | | | | - Matthew Sibley
- Royal London Hospital, London, UK; University Hospitals Birmingham, Birmingham, UK
| | | | | | | | | | | | | | - Raj Menon
- Royal London Hospital, London, UK; National University Hospital, Singapore
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5
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Doughty H, Green L. Transfusion support during mass casualty events. Br J Anaesth 2021; 128:e75-e79. [PMID: 34503826 DOI: 10.1016/j.bja.2021.07.027] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Revised: 06/17/2021] [Accepted: 07/12/2021] [Indexed: 12/24/2022] Open
Abstract
Transfusion support is an essential element of modern emergency healthcare. Blood services together with hospital transfusion teams are required to prepare for, and respond to, mass casualty events as part of wider healthcare emergency planning. Preparedness is a constant collaborative process that actively identifies and manages potential risks, to prevent such events becoming a 'disaster'. The aim of transfusion support during incidents is to provide sufficient and timely supply of blood components and diagnostic services, whilst maintaining support to other patients not involved in the event.
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Affiliation(s)
- Heidi Doughty
- NHS Blood and Transplant, UK; NIHR Surgical Reconstruction and Microbiology Research Centre, Birmingham, UK.
| | - Laura Green
- NHS Blood and Transplant, UK; Barts Health NHS Trust, London, UK; Blizzard Institute, Queen Mary University of London, London, UK
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6
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Chowdhury F, Doughty H, Batrick N. London 2017: Lessons learned in transfusion emergency planning. Transfus Med 2021; 31:81-87. [PMID: 33453080 DOI: 10.1111/tme.12759] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2019] [Accepted: 12/29/2020] [Indexed: 01/21/2023]
Abstract
BACKGROUND AND OBJECTIVES Hospitals prepare for emergencies, but the impact on transfusion staff is rarely discussed. We describe the transfusion response to four major incidents (MIs) during a 6-month period. Three events were due to terrorist attacks, and the fourth was the Grenfell Tower fire. The aim of this paper was to share the practical lessons identified. METHODS This was a retrospective review of four MIs in 2017 using patient administration systems, MI documentation and post-incident debriefs. Blood issue, usage and adverse events during the four activation periods were identified using the Laboratory Information Management System (TelePath). RESULTS Thirty-four patients were admitted (18 P1, 4 P2, 11 P3 and 1 dead). Forty-five blood samples were received: 24 related to nine MI P1 patients. Four P1s received blood components, three with trauma and one with burns, and 35 components were issued. Total components used were six red blood cells (RBC), six fresh frozen plasma (FFP) and two cryoprecipitate pools. Early lessons identified included sample labelling errors (4/24). Errors resolved following the deployment of transfusion staff within the emergency department. Components were over-ordered, leading to time-expiry wastage of platelets. Careful staff management ensured continuity of transfusion services beyond the immediate response period. Debriefing sessions provided staff with support and enabled lessons to be shared. CONCLUSIONS Transfusion teams were involved in repeated incidents. The demand for blood was minimal. Workload was related to sample handling rather than component issue. A shared situational awareness would improve stock management. A laboratory debriefing system offered valuable feedback for service improvement, staff training and support.
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Affiliation(s)
- Fatts Chowdhury
- Imperial College Healthcare NHS Trust, London, UK.,NHS Blood and Transplant, UK
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Servotte JC, Welch-Horan TB, Mullan P, Piazza J, Ghuysen A, Szyld D. Development and implementation of an end-of-shift clinical debriefing method for emergency departments during COVID-19. Adv Simul (Lond) 2020; 5:32. [PMID: 33292850 PMCID: PMC7656224 DOI: 10.1186/s41077-020-00150-0] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Accepted: 10/22/2020] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Multiple guidelines recommend debriefing after clinical events in the emergency department (ED) to improve performance, but their implementation has been limited. We aimed to start a clinical debriefing program to identify opportunities to address teamwork and patient safety during the COVID-19 pandemic. METHODS We reviewed existing literature on best-practice guidelines to answer key clinical debriefing program design questions. An end-of-shift huddle format for the debriefs allowed multiple cases of suspected or confirmed COVID-19 illness to be discussed in the same session, promoting situational awareness and team learning. A novel ED-based clinical debriefing tool was implemented and titled Debriefing In Situ COVID-19 to Encourage Reflection and Plus-Delta in Healthcare After Shifts End (DISCOVER-PHASE). A facilitator experienced in simulation debriefings would facilitate a short (10-25 min) discussion of the relevant cases by following a scripted series of stages for debriefing. Data on the number of debriefing opportunities, frequency of utilization of debriefing, debriefing location, and professional background of the facilitator were analyzed. RESULTS During the study period, the ED treated 3386 suspected or confirmed COVID-19 cases, with 11 deaths and 77 ICU admissions. Of the 187 debriefing opportunities in the first 8-week period, 163 (87.2%) were performed. Of the 24 debriefings not performed, 21 (87.5%) of these were during the four first weeks (21/24; 87.5%). Clinical debriefings had a median duration of 10 min (IQR 7-13). They were mostly facilitated by a nurse (85.9%) and mainly performed remotely (89.8%). CONCLUSION Debriefing with DISCOVER-PHASE during the COVID-19 pandemic were performed often, were relatively brief, and were most often led remotely by a nurse facilitator. Future research should describe the clinical and organizational impact of this DISCOVER-PHASE.
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Affiliation(s)
- Jean-Christophe Servotte
- Public Health Sciences Department, University of Liege, Liege, Belgium
- Interdisciplinary Medical Simulation Center of Liege, University of Liege, Liege, Belgium
| | - T. Bram Welch-Horan
- Director of Simulation, Section of Pediatric Emergency Medicine, Baylor College of Medicine, Texas Children’s Hospital, Houston, TX USA
| | - Paul Mullan
- Director of Research and Quality Improvement, Division of Emergency Medicine, Children’s Hospital of the King’s Daughters, Eastern Virginia Medical School, Norfolk, VA USA
| | - Justine Piazza
- Interdisciplinary Medical Simulation Center of Liege, University of Liege, Liege, Belgium
- Emergency Department, University Hospital Centre of Liege, Liege, Belgium
| | - Alexandre Ghuysen
- Public Health Sciences Department, University of Liege, Liege, Belgium
- Interdisciplinary Medical Simulation Center of Liege, University of Liege, Liege, Belgium
- Emergency Department, University Hospital Centre of Liege, Liege, Belgium
| | - Demian Szyld
- Senior Director, Institute for Medical Simulation, Center for Medical Simulation, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA USA
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8
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Doughty H, Green L, Callum J, Murphy MF. Triage tool for the rationing of blood for massively bleeding patients during a severe national blood shortage: guidance from the National Blood Transfusion Committee. Br J Haematol 2020; 191:340-346. [PMID: 32436251 PMCID: PMC7280686 DOI: 10.1111/bjh.16736] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Revised: 04/20/2020] [Accepted: 04/20/2020] [Indexed: 11/30/2022]
Abstract
The emerging COVID-19 pandemic has overwhelmed healthcare resources worldwide, and for transfusion services this could potentially result in rapid imbalance between supply and demand due to a severe shortage of blood donors. This may result in insufficient blood components to meet every patient's needs resulting in difficult decisions about which patients with major bleeding do and do not receive active transfusion support. This document, which was prepared on behalf of the National Blood Transfusion Committee in England, provides a framework and triage tool to guide the allocation of blood for patients with massive haemorrhage during severe blood shortage. Its goal is to provide blood transfusions in an ethical, fair, and transparent way to ensure that the greatest number of life years are saved. It is based on an evidence- and ethics-based Canadian framework, and would become operational where demand for blood greatly exceeds supply, and where all measures to manage supply and demand have been exhausted. The guidance complements existing national shortage plans for red cells and platelets.
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Affiliation(s)
| | - Laura Green
- NHS Blood & TransplantWatfordUK
- Barts HealthLondonUK
- Blizard InstituteQueen Mary University of LondonLondonUK
| | - Jeannie Callum
- Sunnybrook Health Sciences CentreTorontoONCanada
- University of TorontoTorontoONCanada
| | - Michael F. Murphy
- NHS Blood & TransplantWatfordUK
- Oxford University HospitalsOxfordUK
- University of OxfordOxfordUK
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Apelseth TO, Strandenes G, Kristoffersen EK, Hagen KG, Braathen H, Hervig T. How do I implement a whole blood–based blood preparedness program in a small rural hospital? Transfusion 2020; 60:2793-2800. [DOI: 10.1111/trf.16057] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Revised: 06/27/2020] [Accepted: 06/27/2020] [Indexed: 12/17/2022]
Affiliation(s)
- Torunn O. Apelseth
- Department of Immunology and Transfusion Medicine Haukeland University Hospital Bergen Norway
- Department of War Surgery and Emergency Medicine Norwegian Armed Forces Medical Services Oslo Norway
| | - Geir Strandenes
- Department of Immunology and Transfusion Medicine Haukeland University Hospital Bergen Norway
- Department of War Surgery and Emergency Medicine Norwegian Armed Forces Medical Services Oslo Norway
| | - Einar K. Kristoffersen
- Department of Immunology and Transfusion Medicine Haukeland University Hospital Bergen Norway
- Institute of Clinical Science University of Bergen Bergen Norway
| | - Kristin G. Hagen
- Department of Immunology and Transfusion Medicine Haukeland University Hospital Bergen Norway
| | - Hanne Braathen
- Department of Immunology and Transfusion Medicine Haukeland University Hospital Bergen Norway
- Institute of Clinical Science University of Bergen Bergen Norway
| | - Tor Hervig
- Department of Immunology and Transfusion Medicine Haukeland University Hospital Bergen Norway
- Institute of Clinical Science University of Bergen Bergen Norway
- Haugesund Hospital Haugesund Norway
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10
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Doughty H, Chowdhury F. Emergency preparedness, resilience and response guidance for UK hospital transfusion teams. Transfus Med 2020; 30:177-185. [PMID: 32020684 PMCID: PMC7317494 DOI: 10.1111/tme.12665] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2019] [Revised: 12/23/2019] [Accepted: 01/13/2020] [Indexed: 01/19/2023]
Abstract
OBJECTIVES To present Emergency Preparedness, Resilience and Response (EPRR) guidance for Hospital Transfusion Teams on behalf of the National Blood Transfusion Committee emergency planning working group. BACKGROUND The Civil Contingencies Act 2004 requires healthcare organisations to demonstrate that they can deal with major incidents while maintaining critical services. Recent mass casualty events and the use of transfusion-based resuscitation have highlighted the evolving role of the Hospital Transfusion Team. METHODS This multi-disciplinary advice is informed by recent global and national experience, the 2018 NHS England clinical guidelines for Major Incidents, and stakeholder workshops. GUIDANCE Transfusion staff should be familiar with local EPRR plans including casualty type and numbers. Staff should be exercised as part of wider Trust preparation, with documented roles and responsibilities. Transfusion support should be proactive and include blood issue, regulatory compliance and sample handling. Robust LIMS-compatible emergency identification systems are essential to minimise errors. Emergency stock management requires rapid assessment of existing stock and estimated demand before re-ordering. Initial demand should be based on 2 to 4 red blood cells (RBC) per patient admitted. Patients with significant haemorrhage may require further red cells and early haemostatic support. Where "universal" components are demanded, they should be gender appropriate. Senior staff should lead the response, log and communicate key decisions, and prepare for post-incident recovery. CONCLUSIONS Transfusion teams have an important role in ensuring continuity of transfusion support. Teams should develop their EPRR plans based on local plans and national guidance. Emergency preparedness should include post-incident debriefing for ongoing staff support and future service improvement.
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Affiliation(s)
- Heidi Doughty
- NHS Blood and TransplantClinical Services, BirminghamUnited Kingdom
| | - Fateha Chowdhury
- NHS Blood and TransplantClinical Services, BirminghamUnited Kingdom
- Imperial College Healthcare NHS TrustLondonUnited Kingdom
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