Table 5.

Survey of committee's recommendations for structure quality

Structure improvement by	Number	Percentage of all recommendations
Emergency box of a collection of blood and blood products for trauma and massive bleeding incl. sampling tubes	5	1.57
Establishment of clinical hemotherapy pathways* for patient blood management, bridging of coumarins and new oral anticoagulants, or for emergency revision surgery	9	2.82
Central coagulation and hemostasis consultant emergency phone	8	2.51
Staining dye for e.g. heparin that avoids confusion with another drug	6	1.88
Central IT registry for patients with multiple antibodies	2	0.63
Establish or install backup for defect POCT in OR, ICU (blood gas, coagulation, hemoglobin)	13	4.08
IT controlled storage and software check for the availability of blood products in the storage	3	0.94
Establish or use blood volume monitor (cardiac output and ejection fraction variability)	8	2.51
ID wrist bands for patient identification / scanner based ID check, bar code scanner for the administration of drugs and blood products	17	5.33
ID identity and compatibility check of blood product, probe and patient	18	5.64
Communication / compatibility of PDMS, laboratory and blood banking software (e.g. for plausibility check, also for documentation of a single patient history for all disciplines within the institution, match of type and screen with selected product, warning sign for drug orders and decreased liver or kidney function, documentation of type and screen test result, actual match of estimated blood loss with actual blood loss calculated from hemoglobin content)	48	15.05
IT control of electronic blood product and coagulation product order, feedback of blood product availability in storage, automated blood product order for blood loss surgery, indication check and match with guidelines,	27	8.46
Change or improve blood/coagulation product release of blood bank or depot and delivery (other than IT solutions)	5	1.57
Change medical device or drug / use other existing device or drug / introduce new/other/more drugs or medical devices	19	5.96
Indication check by the computerized order entry system	7	2.19
Use warning sign on devices or blood products	9	2.82
Establish / shut down satellite blood depot	1/2	0.94
GPS/RFID based tracking of blood products or blood samples or other form of transport and delivery documentation, IT based work status information	7	2.19
IT control of autologous blood donation and cell salvage (scale, printer, donor identity, quality, outcome, infection rate)	6	1.88
IT control of allogeneic blood product processing and production, document print	2	0.63
Change blood product label, package or concentration or Improve label printer software, bar code scanner based labeling and printing	10	3.13
Check personnel structure, Improve/increase staffing (quality, qualification or quantity, use shift or rotation models, prepare for emergency or mass transfusion, use documentation assistance on ward, use personnel scheduling software)	14	4.39
Cell saver software / warming device/ blood donation scale software or device improvement	8	2.51
Introduce new / change care structures (satellite pharmacy in the OR; genetic testing for coagulation disorder from the general practitioner; do not use tourniquets for knee surgery; unique patient ID number such as the social security number; dedicated venipuncture team; intermediate care ward, team coaching or communication training; enforce care in level 1 hospitals for rare diseases; use miniprobes for blood tests in adult ICU to minimize iatrogenic blood loss)	12 (1, 1, 1, 1, 1, 2, 2, 1, 2 see details in brackets left)	3.76
Other IT or communication solutions (create unique ID for unknown subjects; check temperature of blood product itself in heating devices; use other paging device; communication of infusion pump with PDMS, text message for alarming laboratory values onto pager, handheld or cell phone; software for medical orders that considers GFR of recipient)	6 (1, 1, 1, 2, 1 (see details in brackets left)	1.88
Change of laws and guidelines (erase blood group from autologous blood**; introduce obligatory user license for hemotherapy and cell salvage etc.)	6 (3, 3 see details in brackets left)	1.88
Delta-check of laboratory values	8	2.51
Separate delivery and storage of various blood autologous and allogeneic products for same recipient, separation of same products for multiple recipients	6 (4, 2 see details in brackets left)	1.88
Information chip about blood group, antibodies, coagulation disorder, or organ malfunction on electronic insurance card or in electronic data base	13	4.08
Improve blood product transport (temperature preservation and control)	4	1.25
Improve only transfusion documentation software (1 product for 2 subjects/kids)	1	0.31
Ensure information access about hemotherapy guidelines via intranet, handheld, etc.	1	0.31
Use electronic warnings or alert signs (other than for mismatches of KIS and laboratory / blood banking data: i.e., for organ malfunction on electronic chart; obligatory WHO checklist for or admission or or management software with alert warning function, in PDMS for discontinuation of coagulation drugs, …)	8	2.51

^*Clinical pathways (CP) were considered structure quality. As opposed to a standard operating procedure or algorithm, CP requires special structures and personnel dedicated to the CP.

^**The deletion of the labeled blood group from autologous units has several advantages: 1- the match has to be by identity or signature instead of a universal blood group that fits many; 2- the autologous product is issued and labeled very different from allogeneic products. It works perfectly for cell saver blood and might improve administration safety for PAD blood, too.

ID = Identification document; GFR = glomerular filtration rate; KIS = hospital information system, PDMS = patient data management system; OR = operation room; ICU = intensive care unit; POCT = point of care testing; WHO = World Health Organization.