Transfusion Transformation Symposium

A recent symposium discussed the current priorities and challenges in transfusion, charting a course for the next 5 years of transfusion strategy. Here, transfusion colleagues summarise the educational talks, questions and commentary, and engaging panel discussions that shaped the symposium.

The Transfusion Transformation Symposium was held on 10 June 2024, organised in partnership between NHS Blood and Transplant (NHSBT), the National Blood Transfusion Committee (NBTC) and NHS England (NHSE). Building further on the previous Transfusion 2024 plan and taking on board lessons learnt from recent blood shortages and the Infected Blood Inquiry (IBI), 3 main strategic aims were considered: the appropriate use of blood, transfusion digital interoperability and stabilising the transfusion workforce.

Professor Cheng-Hock Toh and Dr Gail Miflin welcomed delegates on behalf of NBTC and NHSBT and the meeting was opened by Sir Steve Powis, NHSE National Medical Director.

Improving safety and resilience in transfusion

 

Session 2 tackled ways to bolster safety and resilience in transfusion. Patient empowerment and the need to build a robust workforce emerged as top priorities; the session emphasised leveraging the IBI recommendations for change.

The annual Serious Hazards of Transfusion (SHOT) report continues to offer valuable lessons for improving patient safety. Dr Shruthi Narayan reminded us that these insights must translate into tangible changes, particularly for high-risk groups, including paediatric patients, patients with haemoglobinopathies and those who are regularly transfused. The rising trend of errors and near misses underscores the critical need for well-resourced and robust IT systems, appropriate staffing numbers and comprehensive training.

Kerry Dowling shed light on the alarming picture painted by the UK Transfusion Laboratory Collaborative (UKTLC) surveys in 2019 and 2022. Staff shortages in transfusion laboratories persist; nearly 20% of staff do not feel psychologically safe in their workplace and nearly 50% have faced workplace incivility. To prevent exacerbating this crisis, we need to foster collaboration between clinical and laboratory teams and give laboratory staff a voice in the wider hospital. A robust workforce is not just ‘nice to have’ but is essential for efficiency and patient safety.

Dr Laura Green discussed the evaluation and health economic benefits of implementing bedside electronic vein-to-vein tracking at Barts Health. These systems demonstrably enhance patient and staff experience, improve safety and efficiency, and generate valuable data for evidence-based improvement.

Improving the visibility of blood stocks and tackling wastage is essential for ensuring a sustainable and resilient blood supply. We heard from Matthew Bend about how data-sharing between hospitals and NHSBT can offer a powerful tool to guide, influence and evidence change. Jane Mills spoke about how improvements in digital data and technology in transfusion align with transformation across the 27 pathology networks in England. For more information, please see the previous Bulletin article on the Future of data in transfusion medicine.

Preventing inappropriate blood use

In the first session, discussions centred around appropriate blood use, highlighting lessons learnt from the amber alert for red cells in 2022 and the use of perioperative strategies to minimise inappropriate transfusion, particularly the use of tranexamic acid.

We heard from Professor Lise Estcourt that, overall, red cells issues are decreasing, but our changing population means more blood is going to medical patients, those with blood cancers and those with haemoglobinopathies. Professor Ian Roberts spoke eloquently and passionately about the use of tranexamic acid to reduce bleeding in surgery – a simple, unequivocally evidence-based, low-risk intervention that is being underused.

Patient blood management strategies and measures to address pre-operative anaemia were described with real-world examples by Professor Ramani Moonesinghe and Dr James Prentis. The effectiveness of these strategies hinges on a multidisciplinary team approach with clear accountability, strong patient partnership and robust mechanisms for feedback.

The panel discussion emphasised the importance of patient engagement and highlighted our persistent failure to seek adequate patient consent, as evidenced by audits of the NICE quality standards. Health literacy in the UK is low; by underestimating the need for simple, clear communication with patients, we exacerbate health inequalities. By empowering patients to understand the rationale behind interventions like tranexamic acid use, we can foster true collaboration in their healthcare.

Innovation to enhance patient care

Finally, session 3 delved into the innovations at the forefront of change in transfusion medicine. We heard from Professor Simon Stanworth about how better data and metrics can be used to support patient care in our rapidly evolving digital landscape and from Professor Dame Sue Hill about the huge advances being made in blood matching. Significant health inequalities currently exist in blood matching, particularly for patients with haemoglobinopathies. Leveraging the advances of blood group genotyping technology for both patients and donors will help to level the playing field and ensure all patients have access to the best-matched blood possible.

Unsurprisingly, the impact of the IBI resonated throughout the day. Dr Su Brailsford stressed that implementing the recommendations outlined in the IBI is of paramount importance and is the shared responsibility of all delegates. These recommendations should be embedded into medical curricula to ensure future generations of doctors are equipped to manage transfusion safely and ethically.

Wendy McSporran highlighted the vital role played by transfusion practitioners and the integral part they will play in implementing IBI recommendations. Currently, they have no standardised job description or career progression. Developing a professional framework for this role requires engagement and support, at both national and individual trust levels.

Just one thing

In a day brimming with complex information, the symposium concluded with a powerful call to action inspired by the late Dr Michael Mosley’s ‘just one thing’ concept. Delegates were challenged to identify a single, achievable step to affect change now. Notably, Professor Cheng-Hock Toh, Chair of the NBTC, pledged to create a patient NBTC co-chair role.

It was a fascinating day. It will be exciting to hear more ideas as delegates reflect on the symposium, contribute to the aligned Transfusion Transformation Strategy and go forth with putting actions into practice.

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