Improvement cycles
| PDSA cycle | Plan/prediction | Do | Study | Act | Time required |
| Baseline | Establish current condition (map blood flow and analyse baseline performance) | ‘Go and see’ analysis | KPI: 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 2020 | 14 weeks |
| A1 | Transfer 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 fridge | KPI: 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 target | 8 weeks |
| A2 | Encourage 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-RCP | KPI: 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 little | 26 weeks |
| B1 | Dedicated 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 slots | KPI: 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 |
| B2 | Change 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 |
| C | Further 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 hospital | Could 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.