What About Fill Rate?
Effective patient blood management (PBM) is clearly an important principle in blood banking and, as part of any reasonable PBM approach, ensuring that we minimize waste is crucial to maintain credibility with our donors and control costs for our hospital customers. But blood product waste management does not equal PBM, and single-focused efforts on waste management could produce unintended (and unacceptable) consequences. In addition to the clinical aspects of PBM, I firmly believe any waste management initiative should have product "fill rate" as a crucial measure of success. If we do not include such a basic measure of performance in our studies and management strategies, we run the risk of cutting waste at the cost of reduced product availability. But how do we measure fill rate? How do we define it?
What may seem to be a pretty straightforward question typically garners a very convoluted response. In benchmarking discussions with other blood operators, it has become painfully clear that we do not have consensus on this important metric. A typical response to the question, "How do you measure your fill rate?" - is, "The number of products shipped compared to the number ordered." Fairly simple, right? But when you pose the inevitable follow-up question, "Do you report the percentage filled at the time the order is placed?" - the usual response is, "Of course not. We measure against the number filled within X hours, or weeks." Then there is the question of blood type substitution, or in the case of platelets, the type of platelet product substitution. Not surprisingly, this broad range of responses on what constitutes "fill rate" makes it difficult to agree upon a single definition. So, we tend to exclude fill rate when targeting blood product waste reduction. Achieving waste reduction is important, but we should do so with an unwavering focus on product availability.
The America's Blood Centers' (ABC) Data Warehouse (DW) initiative requires clear definitions on metrics valuable to blood management efforts, so we have an opportunity to clarify what we mean when reporting data like fill rate. (Note: currently the DW does not capture fill rate but is exploring it.) Furthermore, we can define such metrics in a way that offers consistency and insight into improving performance. This is worthwhile in itself, but it also elevates the importance of maintaining product availability while we reduce waste.
PBM is an approach to transfusion medicine - not a tool. Our insistence on maintaining a comprehensive view of PBM, while pursuing improvements in selected facets of appropriate use, is crucial for enhancing blood services. Let's not forget the product fill rate.
Dave Green, Board President; DGreen@bloodsystems.org