Evaluation of bedside electronic transfusion checks (BETC)
Research type
Research Study
Full title
Evaluation of benefits and cost-effectiveness of implementing bedside electronic transfusion checks (BETC) at Barts Health NHS Trust.
IRAS ID
311676
Contact name
Laura Green
Contact email
Sponsor organisation
Queen Mary University of London
Duration of Study in the UK
3 years, 6 months, 30 days
Research summary
Research Summary
Between 2022 - 2025 the current bedside transfusion manual system at four hospitals at Barts Health Trust (BHT) will be replaced with bedside electronic transfusion checks (BETC). It is expected that the BETC will not only improve patient’s safety, but also (1) reduce incorrect sample-labelling for identification of blood grouping, (2) save staff time and (3) Improve traceability of blood components.
Despite the above potential advantages with the use of BETC, its benefits to patients, healthcare professionals, and healthcare providers have not been quantified previously. As healthcare expenditures are rising worldwide, policymakers and healthcare providers need to ensure that the healthcare systems are able to achieve the highest quality of care with good value for investment.Implementation of BETC also provides a huge opportunity for BH to utilize transfusion data in a more innovative way, by creating an efficient method of linking patient data within hospital databases at BH to test current and novel transfusion strategies with immense benefits for patients. Being able to collect real time data on timing when blood transfusion was started would allow us to better evaluate its impact on clinical outcomes.
The implementation of BETC at four hospitals at BH is an excellent opportunity for us to evaluate the effectiveness and value for money of this technology at BH in comparison to the manual blood transfusion system that most hospitals currently use in the UK.
Summary of Results
Barts Health NHS Trust is one of the highest users of blood in the UK, with around 60,000 units transfused annually to 15,000 patients. To deliver a high-quality and safe transfusion service, it is critical that every step is executed to the highest standard to avoid errors, such as the wrong blood being given to the wrong patient, which can have potentially lethal outcomes.
Reports from the UK haemovigilance scheme Serious Hazards of Transfusion show that errors at the bedside remain the leading cause of transfusion-related adverse events, often attributed to the complexity of manual processes and lapses in attention of positive patient identification process at the bedside. The introduction of bedside electronic transfusion checks (BETC) can reduce errors by replacing patient identification checks with electronic verification steps for the labelling of group and screen (G&S) blood samples and the blood administration. Furthermore, the electronic system can improve efficiency by streamlining the transfusion process, reduce G&S sample rejection rates due to mislabelling errors, and remove the need for the second nurse to be present for blood administration checks. The use of BETC system also provides an opportunity to create a complete electronic audit trail of the transfusion process and blood traceability (a legal requirement), as well as allow for the data integration between different IT systems in the trust.
Between 2022 – 2025, four hospitals (Saint Bartholomew’s [SBH], Newham University [NUH], Royal London [RLH] and Whipps Cross [WCH]) at Barts Health NHS Trust replaced the bedside transfusion manual checks with BETC in all clinical wards. Outpatient departments were excluded from the scope, as patients do not wear wristbands, which is essential for the use of bedside electronic devices. A total of 471 Blood Track Tx® devices consisting of Zebra® TC-52 personal digital assistants (PDAs) with an android operating system, Zebra® mobile printers and BloodTrack TX® software were purchased to facilitate the real-time tracking and verification of blood transfusions at the bedside.
The main implementation was split into three phases 1) Pre-pilot, 2) Pilot and 3) Full Roll-Out. The pre-pilot stage addressed the technical IT challenges to allow for the integration of the new devices in the clinical and laboratory transfusion-related workflows (Year 1). The pilot phase was performed in the Haematology Day Units at SBH and RLH (May 2023) to identify and resolve any unforeseen issues that were not picked up in the pre-pilot work. A phased implementation strategy was adopted for the full roll-out over the two years, which included the training of all clinical staff who label G&S samples and administer blood at four hospitals. A total 5060 clinical staff were trained. Training was delivered face-to-face. Initially, a target of 60% was agreed for the staff training before each hospital was allowed to go live with BETC: however, this approach did not result in high uptake of the system, so the threshold was increased to at least 80%.
To ensure the continued success of the Bedside Electronic Transfusion Checks, it is essential that there is ongoing training and support for clinical staff. Regular monthly monitoring of the use of devices by transfusion team through key performance indicators that have been created is required to identify potential areas for improvement and obtain optimal performance and efficiency. To obtain the maximum benefits of the system we also recommend that BETC system is integrated with other hospital IT systems to enhance data sharing and reporting of transfusion activities to clinical areas. Additionally, educating patients and their families about the benefits and safety measures of the system will build trust and confidence in the transfusion process. Continuous monitoring and evaluation of the system's performance, along with gathering user feedback, will allow for necessary adjustments and improvements, ultimately enhancing the safety, efficiency, and overall quality of the hospital transfusion services.
REC name
North West - Greater Manchester East Research Ethics Committee
REC reference
22/NW/0138
Date of REC Opinion
16 May 2022
REC opinion
Further Information Favourable Opinion