| Abstract|| |
Background: Performance monitoring is an important tool which can be used for setting priorities for process improvement. At our centre, we have been monitoring every step in the processes, right from inventory of consumables (both critical and routine) to number of donors reactive for TTI. We conducted a study to measure the impact of monitoring Performance Indicators and how it could be used as a tool for Continuous Quality Improvement (CQI). Materials and Methods: The present study was a retrospective study where the performance indicator (PI) data of blood bank was analyzed for over four years. For certain parameters, benchmarks or thresholds were set that represented warning limits or action limits. The yearly data were collated from monthly data. "Shifts" or "Trends", if any, were identified and Corrective and Preventive Action (CAPA) taken accordingly. At the end, outcomes of the analysis were charted. Results: After the yearly data evaluation, outcomes obtained were used to plan, correct and amend processes and systems in the blood center. It was observed that the workload of the center showed an upward trend. This helped us to plan for the purchase of consumables and management of manpower. The monitoring of usage and discard of blood helped in the efficient management of blood stocks. The need for any new equipment could also be judged by the trends in workload. Conclusion: Performance indicators are indispensible tools which various stakeholders in the Blood Transfusion centres should implement to improve on quality performance.
Keywords: Blood center, continuous quality improvement (CQI), performance indicator (PI) monitoring
|How to cite this article:|
Bhatnagar NM, Soni S, Gajjar M, Shah M, Shah S, Patel V. Performance indicators: A tool for continuous quality improvement. Asian J Transfus Sci 2016;10:42-7
|How to cite this URL:|
Bhatnagar NM, Soni S, Gajjar M, Shah M, Shah S, Patel V. Performance indicators: A tool for continuous quality improvement. Asian J Transfus Sci [serial online] 2016 [cited 2021 Oct 21];10:42-7. Available from: https://www.ajts.org/text.asp?2016/10/1/42/175398
| Background|| |
A quality management system includes the organizational structure, responsibilities, policies, processes, procedures, and resources established by the management to achieve and maintain quality. The purpose of quality checks is to provide feedback to the operational staff about the state of a process that is in progress. Examples of quality control measures include reagent quality control (QC), product QC, clerical checks, and temperature measurements.
On the other hand, quality assurance activities are not tied to the actual performance of a process. Rather, they include activities such as the development of documents such as standard operating procedures (SOPs) and training of personnel. They also include retrospective reviews and analyses of operational performance data to determine whether the overall process is in a state of control and to detect "shifts" and "trends" that require attention.
Performance monitoring is an important tool, which can be used for setting priorities for process improvement.  It is defined as a method by which procedures, activities, or human resources can be assessed on certain parameters keeping the preestablished criteria and objectives as a benchmark. It is a well-established procedure in the human resource department worldwide. Benchmarking is a structured, continuous, collaborative process in which comparisons for selected indicators are used to identify factors, which when implemented will improve transfusion practices. Performance monitoring is one type of internal audit, which helps us to improve our quality standards in transfusion practices. The present study was conducted to measure the impact of monitoring performance indicators (PIs) and how they could be used as a tool for continuous quality improvement (CQI).
| Materials and Methods|| |
The present study was conducted in a tertiary care multispeciality hospital-based blood bank, catering to all types of patients.
The present study was a retrospective study where the PI data of the blood bank were analyzed for over 4 years. For certain parameters, benchmarks or thresholds were set that represented warning limits or action limits. The yearly data were collated from monthly data. "Shifts" or "trends," if any, were identified and corrective and preventive action (CAPA) was taken accordingly.
At the end, outcomes of the analysis were charted.
of performance indicators measured
Performance indicators measured yearly
[Additional file 1]
[Additional file 2]
[Additional file 3]
[Additional file 4]
- Number of blood donations with type of donations.
- Number of adverse donor reactions.
- Number of blood groupings and antibody screenings.
- Crossmatch:transfusion ratio.
- Number of transfusion transmitted infection-reactive donors.
- Total number of components discarded.
- Number of adverse transfusion reactions.
| Results|| |
The PI data of the blood bank was analyzed for over 4 years. The yearly data were collated from the monthly data. The data of some of the parameters are as follows [Table 1],[Table 2],[Table 3],[Table 4],[Table 5],[Table 6],[Table 7] and [Table 8] and [Figure 1],[Figure 2],[Figure 3],[Figure 4],[Figure 5] and [Figure 6].
After the yearly data monitoring, outcomes obtained were used to plan, correct, and amend processes and systems in the blood center.
| Discussion|| |
For all operations in blood bank, critical control points (CCPs), and key elements (KEs) can be delineated. Each center can list out its own CCPs and start a process of monitoring them. CCPs are those major processes of the operating systems that have to function properly if quality outcomes must be obtained. On the other hand, KEs are operational steps that lead to CCPs. These KEs have to be effectively managed for the process to be free from errors. Identification of the CCPs and KEs for transfusion medicine operational system therefore, is a fundamental prerequisite for determining where quality indicators placements are desirable.  CCPs give an "objective" assessment of process flow in a transfusion center.
AABB has described "monitoring and assessment" as a component of quality management system. Assessments are systematic examinations to determine whether actual activities comply with planned activities, are implemented effectively, and achieve objectives. Assessments can be internal or external. Quality indicators are performance measures designed to monitor one or more processes during a defined time and are useful for evaluating service demands, production, personnel, inventory control, and process stability.
Most of the studies on quality indicators worldwide are based on the monitoring of data such as the crossmatch:transfusion (CT) ratio, the rate of red blood cell (RBC) unit expiration, and the rate of RBC unit wastage. These tools are fundamental for monitoring the "usage of blood." A study by David et al.  evaluates the various practice characteristics in 1,639 institutions across the USA. The authors have analyzed the CT ratio, RBC unit expiration rate, and RBC wastage rates in different institutions. A study by Memtombi et al.  evaluates the CT ratio, transfusion index, transfusion probability, RBC unit expiration rate, RBC unit wastage rate, packed RBC: whole blood ratio.
Not many studies have evaluated the PIs for all operations in a blood bank. At our center, we have been monitoring every step in the processes, right from the inventory of consumables (both critical and routine) to the number of donors reactive for TTI. This has helped our center achieve higher standards of services. The staff at all cadres is trained to identify, assess, and report any outliers so that root cause analysis and appropriate actions could be taken timely.
The monitoring of adverse transfusion reactions showed a decreased incidence. This could be because of the implementation of the Blood Bank Data Management System (BDMS) (Manufacturer: Easy Software), a software catering to all functions of the blood bank. Chances of error have been reduced greatly. Another reason could be underreporting from the clinical side. Mild reactions are treated and not reported to the blood bank. Regular annual training given to all hospital staff includes topics such as "hemovigilance" to increase awareness regarding the reporting of adverse events related to blood transfusion.
Our CT ratio was also under acceptable limits. Regular CMEs have helped us to maintain it below 2.
The ultimate goal of quality improvement is to enable an organization to attain higher levels of performance by creating new or better standards or removing the deficiencies in products, processes, or services. These improvements must be based on data-driven analysis; an ongoing measurement and an assessment program are fundamental to that process. 
Process control allows the staff to recognize when things are going wrong and to make appropriate modifications or amendments in the process. Performance monitoring should be done by comparing the actual results to expected results. Monitoring may include quality indicator data or targeted audits of a single process. It enables the early detection of trends or problems and makes it possible to develop preventive actions before blood components, and ultimately patient safety is adversely affected.
| Conclusion|| |
For the smooth functioning of blood transfusion services, it is of utmost importance that the CCPs be identified and be constantly monitored. By doing this, we are assured that at no point, there is laxity of services. The ultimate goal is to provide safe transfusion to the patients.
Quality indicators are indispensable tools, which various stakeholders in the blood transfusion establishment now demand to adjudge and improve quality performance. Practitioners as well as policymakers in transfusion medicine need to ensure that the quality indicators they institute are appropriately selected and analyzed to be effective and efficient monitors of quality. Knowledge of basic building blocks of CCPs is therefore, a fundamental prerequisite.
Performance monitoring is a proactive strategy, which allows the consultants in transfusion medicine to have the reins of the blood bank in their hands and the assurance that quality work is being done at the blood center.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Motschman TL, Jett BW, Wilkinson SL. Quality management systems: Theory and practice. In: Fung MK, Grossman BJ, Hillyer CD, editors. Technical Manual. 18 th
ed. Bethesda, MD: American Association of Blood Banks (AABB); p. 1-38.
Anyaegbu CC. Quality indicators in transfusion medicine: The building blocks. ISBT Sci Ser 2011;6:35-45.
Novis DA, Renner S, Friedberg R, Walsh MK, Saladino AJ. Quality indicators of blood utilization: Three College of American Pathologists Q-Probes studies of 12,288,404 red blood cell units in 1639 hospitals. Arch Pathol Lab Med 2002;126:150-6.
Devi KM, Sharma AB, Singh LD, Vijayanta K, Lalhriatpuii ST, Singh AM. Quality indicators of blood utilization in the tertiary care center in the north-eastern India. J Dent Med Sci 2014;13:50-2.
World Health Organization. Quality Systems for Blood Safety. Quality Management training for Blood Transfusion Services, Modules1-5: World Health Organization; 2005. p. 17.
Nidhi M Bhatnagar
2nd Floor, Kamdhenu Complex, Toran Dining Hall Lane, Opposite Sales India, Ashram Road, Ahmedabad - 380 009, Gujarat
Source of Support: None, Conflict of Interest: None
[Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 6]
[Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6], [Table 7], [Table 8]