Table 1

Improvement cycles

PDSA cyclePlan/predictionDoStudyActTime required
BaselineEstablish current condition (map blood flow and analyse baseline performance)‘Go and see’ analysisKPI: mean weekly wastage=8.36 units (70%)
PM: median % age ≤2 days=42% per week(oldest=9 days)
Embark on cycles of improvement, aiming for mean weekly wastage less than or equal to one unit (8%) by November 202014 weeks
A1Transfer near-expiry units to the ED
Hypothesis: ED staff can make good use of LD-RCP for trauma patients
First target: KPI: mean weekly wastage=six units (50%)
At age=10 days move LD-RCP to the ED fridgeKPI: mean weekly wastage=5.88 units (49%)
(PM: median % age ≤2 days=no change)
Some ED patients eligible to receive LD-RCP had not, despite availability in the ED fridge
First target achieved but capability low (achieved in six out of the 8 weeks). Review highlighted that further work was required: conduct another cycle with modified plan and more ambitious target8 weeks
A2Encourage use by ED staff
Hypothesis: trauma research fellows (TRFs) could establish LD-RCP use as routine practice for ED staff
Second target: KPI: mean weekly wastage=four units (33%)
Existing TRFs work in the ED to assist with education, training and prompting use of LD-RCPKPI: mean weekly wastage=4.54 units (38%)
(PM: median % age ≤2 days=no change)
SPC (figure 2) suggests effective after a time lag: four units achieved most weeks in second half but capability low (little safety margin). Further improvement ideas needed; tighten target a little26 weeks
B1Dedicated LD-RCP delivery slot
Hypothesis: more LD-RCP received at age ≤2 if had dedicated delivery slots
Third target: KPI: mean weekly wastage=three units (25%)
Work closely with NHSBT (supplier) using RLH metrics and data, agree dedicated delivery slot rather than the general delivery slotsKPI: mean weekly wastage=3.38 units (28%)
PM: median % age ≤2 days=83% per week
Big improvement in % age ≤2 days (process metric) but only small improvement in mean weekly wastage
Further improvement ideas needed; tighten target a little
13 weeks
B2Change LD-RCP delivery days
Hypothesis: since prehospital trauma incidence highest on Fridays and Saturdays, delivery to cover 2 weekends would decrease wastage
Fourth target: KPI: mean weekly wastage=three units (25%)
Change dedicated delivery days,
Tue: two units, Wed: four units, Thu: two units, Fri: two units, Sat: two units
KPI: mean weekly wastage=3.19 units (27%) (5 weeks with zero wastage)
(PM: median % age ≤2 days: no change expected)
Ultimate target still not met, small further improvement in mean weekly wastage (large improvement since the start). Variation still high
(% age ≤2 days appears to continue to improve)
17 weeks
CFurther extend the LD-RCP pathway to include non-trauma patients with major bleeding.
Hypothesis: will further increase in demand for LD-RCP.
Fifth target: KPI: mean weekly wastage=one unit (8%)
Units’ age ≥10 days to be also used for non-trauma bleeding patients in hospitalCould not be implemented due to the COVID-19 pandemic
  • ED, emergency department; KPI, key performance indicator; LD-RCP, leucodepleted red cell and plasma; NHSBT, NHS Blood and Transplant; PDSA, Plan–Do–Study–Act; PM, process metric; RLH, Royal London Hospital; SPC, Statistical Process Control.