Factors affecting the frequency of red blood cell outdates: an approach to establish benchmarking targets

Benchmarking is a useful tool to identify best practices and to compare an organization's performance with that of similar peers, allowing for continuous quality improvement. In this study, a provincial database of red blood cell (RBC) product inventory/disposition in hospitals was analyzed to identify factors that affected RBC outdates and to systematically establish optimal target levels for RBC outdates. RBC inventory/disposition data for a 21-month period from 156 hospitals were analyzed using logistic regression techniques to identify factors that affected RBC outdating (month of the year, distance from the blood supplier, monthly transfusion activity, hospital type, and provincial region). The results were used to categorize hospitals into groupings that accounted for the factors affecting wastage. Within each grouping, the lower quartile was selected as the optimal target threshold. Three factors were identified as significantly affecting RBC outdating: distance from the blood supplier, mean monthly transfusion activity, and month of the year. Accounting for these variables, three hospital groupings were identified and benchmarking targets were established for mean monthly RBC outdating: There were 73 hospitals in Group 1 and their target level was 0.4 percent, 59 hospitals in Group 2 with a target of 1.1 percent, and 24 hospitals in Group 3 with a target of 20.3 percent. A method is described for establishing evidence-based benchmarking targets for RBC outdating that allows for hospitals to be grouped with similar peers taking into account logistic factors that impact on product outdating.