A quality improvement team on autologous and directed-donor blood availability.

Until 1985, volunteer donors provided blood for almost all transfusions and donated blood was rarely restricted for transfusion to a specific patient. With the AIDS (Acquired Immunodeficiency Syndrome) crisis, autologous (blood from oneself) and directed (blood from families and friends) donations increased, calling for handling of far greater complexity. At the University of California at San Francisco Medical Center, the demand for special donations superseded the development of systems to meet the demand and autologous and/or directed donations were often not available when needed. After a rapid rise in incident reports and complaints from physicians, nurses, patients, and families, a quality improvement (QI) team was formed in mid-1991 to improve blood availability. Meetings were held to analyze the processes involved in blood donation and transfusion, identify and categorize problems, develop interventions, test and implement solutions, and monitor improvements. Educational efforts were implemented throughout the medical center, recruitment for a special donations co-ordinator began, and changes were made in the blood bank's internal systems. In two years, with stable numbers of transfused units, the number of incident reports regarding blood availability decreased from 19 to 2 per year-an improvement that has been sustained for more than three years. The QI team continues to meet regularly to design and implement additional improvements. A QI team has improved the availability of autologous and directed-donor blood to patients and has extended the impact of the QI methodology throughout the medical center as a whole.