Implications of CBS New
Shipping Containers
September 2016
Current State
• Canadian Blood Services (CBS) currently uses
containers known as J82s for deliveries
• CBS does not directly ship to all sites in BC
• Containers are used for 3 streams of activities:
1. Provincial redistribution
2. Intra-health authority distribution
3. Transfer of blood with critically ill patients to higher
acuity care
• CBS plans to implement new shipping containers
(Dec 2016/Jan 2017) which will not be available for
any redistribution or distribution activities*
*CBS presentation July 20, 2016
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Provincial Redistribution
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•
•
•
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2015/16 – redistributed ~11,000 RBC units
From 56 shipping sites to 8 receiver sites
Average 5 RBC units per shipment
~2200 shipments/year
2015/16 RBC Expiry Rate – 1.3% (lowest ever)
• What if… “Let It Go”…Project Elsa
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Red Blood Cells – Provincial Redistribution Map 2014/15
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Project Elsa – Problem Breakdown
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Life Cycle of a Redistributed RBC
7-14 days before expiry date
CBS
distributes
supply to
Hospital A
Shipping Site redistributes to
the Receiving Site
Transfused,
Discarded or
Expired at the
Receiving Site
Expiry
Date
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Methodology
7-14 days before expiry date
RBC Units stay at original site
CBS
distributes
supply to
Hospital A
Look at actual utilization, 7, 10, 14 days before
expiry, in this period of hospital A to
determine whether this unit may have been
used or not.
Estimate
number of
units that
may now
expire
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Scenarios:
• Actual utilization at 7/10/14 days from expiry of each
redistributed unit
The Exact ABO/Rh Match transfusion:
• Was there a recipient transfused with the exact same
blood group?
Acceptable ABO/Rh Substitution transfusion:
• Was there a recipient transfused that could’ve
received a blood group substitution?
• Three years of data for validation
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The number of units estimated to expire if RBC
units had stayed at the shipping sites
Scenario 1- The Exact Match
Year
Using 7 days before
Using 10 days before
expiry as shipping date expiry as shipping date
Using 14 days before
expiry as shipping date
2012/13
6, 031 units
5, 536 units
5, 064 units
2013/14
6, 301 units
5, 698 units
5, 164 units
2014/15
6, 223 units
5, 699 units
5, 156 units
Average
6, 185 units
5, 644 units
5, 128 units
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The number of units estimated to expire if the
RBC units had stayed at the shipping sites
Scenario 2 – Allow Substitution
Year
Using 7 days before
Using 10 days before
expiry as shipping date expiry as shipping date
Using 14 days before
expiry as shipping date
2012/13
3,434 units
2,773 units
2,250 units
2013/14
3,297 units
2,514 units
1,976 units
2014/15
3,379 units
2,611 units
2,010 units
2, 632units
2,078 units
Average 3,370 units
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Impact on Expiry Rate and Cost
Year
Actual
Expiry
Rate
Actual Expiry
Cost
Scenario
Days
Before
Expiry
Estimated
Expiry
Rate
Estimated
Expired Cost
Additional
Expired Cost
14/15
1.5%
$ 979,000
Exact
Match
7
5.7%
$3,931,500
$2,952,500
10
5.3%
$3,669,500
$2,690,500
14
5.0%
$3,398,000
$2,419,000
7
3.7%
$2,509,500
$1,530,500
10
3.1%
$2,125,500
$1,146,500
14
2.7%
$1,825,000
$ 846,000
14/15
1.5%
$ 979,000
Subs
Allowed
- Cost Calculation based on $500 per unit
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Impact on Total Supply
Year
Actual Total
Supply
(Units)
Scenario
Days
Before
Expiry
Additional Supply
From CBS
(Units)
Additional Supply
Cost to CBS ($)
14/15
130, 987
Exact
Match
7
5,531
$2,765,500
10
5,007
$2,503,500
14
4,464
$2,232,000
7
2,687
$1,343,500
10
1,919
$ 959,500
14
1,318
$ 659,000
14/15
130, 987
Subs
Allowed
- Cost Calculation based on $500 per unit
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Conclusion of Project Elsa
• Hospital demand would increase by
estimated 2,000 – 5,000 units
• Expiry rate would increase
• Between 3 – 5%
• Depending on ABO substitution policy:
• Additional Expiry cost $1.2 – 2.7 M
• Additional supply cost $1.0 – 3.0 M
• Increase the number of donors needed
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Intra- Health Authority Distribution
• Hub-and-Spoke Model
• CBS does not directly ship to all sites in BC
• Estimated over 3500 blood components and
6000 blood products distributed were from
hub sites to smaller sites
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Transfers with Patients
• Manual count of available paper records
provided to CTR by hospitals
• 194 transfers (455 blood products)
• Excludes one HA and does not include
numerous transfers within HA…understated
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Impact, Issues & Concerns
• Physical impact:
– VCH OH&S identified concerns re: staff risk due to weight and size of
new containers
• Process impact:
– Hub & spoke models established to streamline process and reduced
tech time and training
– CBS does not currently deliver to all sites in province
• Training & Education:
– Training and competency assessments is a requirement per HC Regs
for anyone involved with handling and receiving blood (approx 900 ppl)
• Financial:
– Short term: Continue using existing J82s (provided by CBS); costs
include box transport (shipping) and labour
– Long term: New shipping containers (J82s or other) for entire province
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Decision
Long–term plan – J82 boxes and supplies,
logistics & transportation
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