Developing clinical performance indicators for pre-hospital blood transfusion: The Thames Valley Air Ambulance approach.

OBJECTIVE: In this article, we describe how we developed and validated key performance indicators (KPIs) for pre-hospital blood transfusion and offer suggestions for other organisations wishing to develop performance metrics. BACKGROUND: KPIs are metrics that compare actual care against an ideal structure, process or outcome standard. An increasing number of UK-based pre-hospital critical care services now carry blood components to enable pre-hospital blood transfusion. METHODS: A working group of pre-hospital physicians and paramedics was formed to create and validate performance indicators that reflected a high-quality pre-hospital transfusion. This was performed by literature searching and reviewing consensus documents that guide the best practice and then adjusting the indicators as the process evolved. RESULTS: Throughout the year, the performance against the domains was monitored monthly and outputs communicated within the clinical staff of the organisation; at the end of the year, the domains were amended. The final list of performance indicators was as follows: (a) rationale for transfusion documented in the notes; (b) rationale for transfusion in line with Thames Valley Air Ambulance blood transfusion guideline; (c) aggressive management of hypothermia; (d) tranexamic acid administered within an hour of injury; (e) evidence of bleeding in hospital; (f) monitoring of adverse effects of blood transfusion; (g) overall-was the use of blood justified; and (h) no units wasted this month. CONCLUSIONS: This study has shown that it is feasible to devise and implement clinical performance indicators for pre-hospital blood transfusion and that their use has increased the focus on this important area.