University of Texas Medical Branch, Texas, United States
Background/Case Studies: Managing platelet inventory in a hospital blood bank is a continual balance between oversupply and wastage versus risking shortages that could jeopardize patient care. Existing literature, however, offers limited guidance on how to design a platelet inventory system that aligns with a hospital’s daily usage and patient needs. The current study outlines steps by a suburban academic medical system with a main campus (500+ beds) and smaller satellite hospitals to optimize platelet inventory in the face of rising platelet wastage. The hospital system has minimal daily outpatient transfusions with major usage being surgeries, trauma, and inpatient care. Due to its location, the hospital cannot depend on blood suppliers for urgent needs.
Study
Design/Methods: Rising month-to-month platelet wastage instigated a retrospective analysis of all platelet transfusions, product wastage, transfusion indications, and the associated costs in the system over the previous 3 months. A new inventory strategy was planned, wherein critical shortage levels are set after the calculated average daily platelet usage of each facility. At critical levels, subsequent platelets would be split into low-dose units. Implementation of low-dose platelets would allow each facility to meet the potential demands of the highest platelet usage day, while also not oversupplying platelet inventory on normal days. To gauge intervention efficacy, the same metrics were tracked subsequently to monitor cost savings and improvement in wastage.
Results/Findings: The main campus averaged 2.3 platelets transfused per day with the smaller affiliates transfusing < 1 platelet per day combined. Range was 0 to 9 platelet transfusions in one day at the main campus. Prior to the intervention, 88.6 platelets were wasted per month across the system ($63,574 monthly cost), with wastage averaging 49.7%. With the new plan, daily platelet pars were targeted at 6 platelets at the main campus and 1-2 platelets for the other campuses, a reduction of ~40% from prior goals. Post-intervention, monthly platelet wastage progressively declined to 43 platelets per month, with monthly wastage averaging 31.8%. Associated cost savings were $32,743 per month, a 51.5% reduction from pre-intervention. Crucially, no patient demand from individual days exceeded total platelet supplies with implementation of low-dose platelets. Conclusions: A novel platelet inventory strategy was developed that effectively reduced platelet wastage with substantial cost savings for a suburban hospital system. Aligning the average daily platelet usage with defined triggers for low-dose platelets may be helpful for other hospital systems similar in profile, which have low daily platelet transfusion demands mixed with high platelet usage variability.
Importance of research: Designing an optimal platelet inventory is a challenge for every blood bank. A framework to help design hospital platelet inventories, however, is lacking in the current literature. The current study outlines solutions to address this gap, at a hospital with an active surgical and trauma center and few outpatient transfusions, and without ready access to emergency supplies from a blood center. Given our success in reducing wastage and costs, our findings may be useful for similar institutions.
