Wednesday, February 27, 2008

Signs you live in the 21st century

As usual, I alone am responsible for the ideas in this blog.

Have you seen these lists about life in the 21st century? They usually begin with jokes such as, "You just tried to enter your password in the microwave. "

This blog is not just about "Automating the transfusion service in the 21st century." It is also about "us and them."

The triggering antecedent for the blog was a television program I watched last year (Canada's Next Great Prime Minister) in which college and university students competed to earn a $50,000 educational scholarship and a 6-mth internship with the contest's sponsor.

One of the questions was, "What do you think will be the overwhelming challenge of the 21st century?" As I recall, the replies included stopping global warming and combating terrorism. But none touched upon what I thought would be one of the most challenging problems that we face.

That problem resurfaced when I read the editorial by Suzanne Butch in the March 2008 issue of Transfusion:
  • Butch S. Automating the transfusion service in the 21st century. Transfusion 2008; 48 (3):406-7.
The editorial supplemented a paper describing work in the UK to develop and test a system for total electronic control of the blood transfusion process:
The UK study evaluated remote blood issue combined with an electronically controlled transfusion process and found that it reduced the time to make blood available for surgical patients and improved transfusion efficiency.

Briefly, the electronic process is as follows:
1. Before transfusing blood, staff use a hand-held computer to make multiple scans prompted by the device:
  • Staff's user identification bar code
  • Identification bar code on patient's wristband
  • Blood unit compatibility label, unit number, and product code
2. The hand-held computer
  • Confirms if the bag is correct for the patient; if not, indicates "Do Not Transfuse" and sounds an alert
  • Prompts users to
  • -->Orally clarify patient's identification (first name, surname, and date of birth) and to check all details displayed on the computer screen
  • -->Perform other essential pretransfusion checks, including unit expiry date
  • -->Enter pretransfusion patient observations into computer
  • Once these checks are completed, prompts users that it is safe to begin the transfusion.
3. A final transfusion report, including observations done during and after transfusion, is printed and kept in the patient's medical records.

4. Information from the hand-held computer is downloaded to a blood bank computer by docking into a computer or by a wireless connection to the hospital network.

[For more on bar codes and RFID, see TraQ's Technology clearinghouse.]

In her editorial Butch notes that technology to improve transfusion safety and documentation has been available since the 1990s but few facilities have implemented total electronic patient identification from specimen collection to testing and transfusion.

She says that now is the time to ask software vendors and instrument manufacturers to develop such systems, whether using bar codes, RFID, or other technologies, in order to provide safer and more efficient use of blood components and human resources. She notes that, although it will be costly, in the USA forces such as the Joint Commission and CAP now advocate better patient identification systems.

Which brings me to the underlying theme of this blog: us and them

We in the West are spending or are preparing to spend a large amount of money to approach total positive identification and reduce transfusion errors caused by misidentification to zero or near zero. Although such errors are rare, we naturally strive to make them even rarer. And we already spend vast sums to prevent transfusion transmitted diseases, some of which are themselves very rare in our societies.

All of which is wonderful - wonderful for us.

But what about blood transfusion in developing countries? A few newspaper items are instructive:

Vietnam: Many in poverty earn a living selling their blood (Feb. 2008)

China: Deadly blood trade (Nov. 2007)

India: Professional blood donors may soon be jailed (Nov. 2007)

India: Most blood banks are not equipped to carry out even mandatory tests for diseases like AIDS, hepatitis B and C (May 2007)

Peru:Families of children infected with HIV via transfusion demand compensation (Sept. 2007)

Trinidad & Tobago: Desperate patients are charged 100s of dollars for a pint of blood (Dec. 2007)

The contrast is clear. We operate Mercedes Benz blood transfusion systems whereas they run horse and buggy operations, if that. We use expensive technology to make transfusion not only safer but more efficient. We have the luxury of striving to be more efficient in a world where transfusion, indeed life, is unsafe for so many.

So what, you say? That's just the way it is in the world and it's not specific to transfusion. In everything, we are haves and they are have-nots. All correct.

Just think that every year there are 500 million - 1/2 billion - new cases of malaria in the world and that every 30 seconds a child dies of malaria (see WHO - Malaria). The numbers for those dying of diarrhea and other preventable conditions are equally staggering. These overpowering problems leave transfusion medicine barely on the health care map in developing countries.

In contrast, we in the West spend millions on food and medical care for our pets, eat ourselves into obesity, complain that we can never remember our passwords because we have too many, and diligently strive to make blood transfusion zero-risk.

And that's a problem - a BIG problem, if not THE problem of the 21st century. With modern communication systems reaching every part of the globe, how long can such inequities continue? How long before the have-nots do something about it? And how can we in good conscience just stand idly by and continue to accept our good fate?

Perhaps the Transfusion papers made me think about global disparities because I have friends working in blood transfusion in Vietnam and Cambodia. They work for a pittance - it is more like volunteering. Their informal reports on the reality is more than you could imagine. Think the worst, then multiply it a 1000 fold.

What can and should be done about these disparities? What can we do as individuals? Some possibilities:
Just some food for thought as we go back to fretting about all the things we fret about in our daily professional lives....

Signs you live in the 21st century really depend on where you were born and live.

If you know of more organizations where individuals can help or would like to give feedback, please click on the comments link below. There are already 2 thoughtful commentaries - many thanks to the contributors.

For those of you who read the blog below (To consolidate or not to consolidate? Who shall inherit the wind?),
there have been several comments added.

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