Reducing the age of transfused red blood cells in hospitals: ordering and allocation policies

BACKGROUND: Although recent randomized controlled trials have not found increased risk of morbidity/mortality with older red blood cells (RBCs), several large trials will be completed soon providing power to detect smaller risks if indeed they exist. Hence, there may still be a need for inventory management policies that could reduce the age of transfused RBCs without compromising availability or resulting in excessive outdates. MATERIALS AND METHODS: We developed a computer simulation model based on data from an acute care hospital in Hamilton, Ontario. We evaluated and compared the performance of certain practical ordering and allocation policies in terms of outdate rate, shortage rate and the distribution of the age of issued RBCs. RESULTS: During the 1-year period for which we analysed the data, 10349 RBC units were transfused with an average issue age of 20·7 days and six units were outdated (outdate rate: 0·06%). Adopting a strict first in, first out (FIFO) allocation policy and an order-up-to ordering policy with target levels set to five times the estimated daily demand for each blood type, reduced the average issue age by 29·4% (to 14·6 days), without an increase in the outdate rate (0·05%) or resulting in any unmet demand. Further reduction of issue age without a significant increase in outdate rate was observed when adopting non-FIFO threshold-based allocation policies and appropriately adjusting the order-up-to levels. CONCLUSION: A significant reduction of issue age could be possible, without compromising availability or resulting in excessive outdates, by properly adjusting the ordering and allocation policies at the hospital level.