Analysis and Optimization of a Regional Blood Bank Distribution Process: II. Derivation and Use of a Method for Evaluating Hospital Management Procedures

The practice of allowing participating hospitals in a regional blood bank system to return unneeded blood units to the central bank for redistribution (recycling) makes it difficult to account for each hospital's role in the production of outdates. The usual blood management efficiency criterion of measuring the rate of outdating occurring at a particular hospital has limited meaning when there is recycling because some hospitals avoid high outdate rates by "dumping" their old units on the central bank, while other hospitals have high outdate rates, because they receive disproportionately large numbers of old blood units which have been returned by other hospitals. By using data from a one-year period at Milwaukee Blood Center, a new blood management efficiency criterion, effective outdate rate, is derived with the use of basic Markovian principles. This is the rate at which a hospital contributes to outdates anywhere in the regional system. The rate for each hospital may be compared to evaluate the relative performance of that hospital. The rate is also converted to a "cost of transfusion" to give a direct "dollar" method for informing hospital blood bank managers of their performance.