Transcript Cell Saver Audit

Cell Saver Audit
Dr Richard Evans (CONS)
Dr Vikram Halikar (SHO)
Dr Kevin Chu (PRHO)
Introduction
• Fresenius CATS (Continuous
AutoTransfusion System)
• Autologous blood transfusion
• Mechanism
–
–
–
–
Citrate
Collection & Filter
Centrifuge & Wash
Haematocrit 60% (depending on
wash)
Why this Audit?
• Usage & efficacy
• Cost implications
• Problems / Suggestions
Why Use A Cell Saver
• Loss of Transfusion Risk
– Infection
– Transfusion Error
– Difficult Cross Match
• Blood Shortage
• Cost Benefits
When not to use a Cell Saver
• Tumour
• Infection
• Chemicals
Data Collected
• Cell Saver audit forms
– August 2002 – April 2003 inclusive
– 9 months
– 48 patients
•
•
•
•
Theatre Ledger
Emergency Operation Lists
Diary of Bookings
Blood bank records
Cell Saver
Audit Forms
Operations
• Vascular
– Emergency AAA
– Elective AAA
• Urology
– Cystectomy
– Prostatectomy
– Nephrectomy
• Orthopaedic
– Revision Hips / Occasional Total Hip Replacment
– Spinal Fusions
Usage - General
45
40
Number of Cases
35
30
25
Cell Saver
Missed Cases
20
15
10
5
0
Vascular
Urology
Operation
Orthopaedics
Usage – AAA Repair
14
12
Number of Cases
10
8
Cell Saver
Missed Cases
6
4
2
0
Elective AAA
Emergency AAA
Operation
Blood Returned & Units Transfused
AAA - Elective
AAA - Emergency
Operation
Spinal Fusion
Cystectomy
Revision Hips / THR
`
Prostatectomy
Nephrectomy
0
0.5
1
1.5
2
2.5
3
3.5
4
4.5
Units
Average Blood Returned (equivalent units)
Average Units Transfused
5
AAA Repair – Units Transfused
Units Transfused
12
10
8
6
4
Missed Cases
2
Cell Saver
0
Emergency
Elective
Cost Effectiveness
• Capital Cost
– Cell Saver £21,000 (Now £14,000)
– ODP Training £300 * 7 = £2,100
• Running Costs (over 9 months)
– 48 cases * £90 disposables/case = £4,320
Cost Effectiveness
• Total Salvaged 24,971ml (over 9 months)
– Approx 250ml / unit i.e. 100 units
– Cost / unit £120
– Total Saved £12,000
• Predicted Saving
– £12,000 - £4,320 = £7,680 (over 9 months)
– £10,240 savings per year (at current usage)
– £160 savings per case
Problems / Missed Cases
• Availability
– Of Cell Saver (double booking)
– Of ODP trained in usage
– Of ODP for usage in Emergency AAA
• Under-usage
– Especially in orthopaedics
– Relatively new technique
– Lack of awareness: surgical & anaesthetic
Conclusions
• Cell Saver is highly cost effective
• Second unit (in orthopaedics) would bring
further cost benefit
• Expanding staff training would allow
greater usage of the machine
Suggestions / Plans
• 2nd Machine for Orthopaedics
• Increase awareness
• Routine collection for
– All Hip operations
– All Knee operations (not using tourniquet)
– Femoral Nails
• Expand staff training
Re-Audit
• This audit was first presented at the
anaesthetic meeting on 5 September 2003
• Re-audit of use 6 months from then
Thank You
Any Questions?