It’s a volume business
At 352,000 blood group and screens tested, and 130,000 blood components issued to patients every year, HSL/TDL’s transfusion division is similar in scale and geography only to the NHS National Blood and Transplant (NHSBT) service.
Even at this volume, it remains a relatively small percentage of the Group’s overall business but, as Etain points out, carries a disproportionate amount of the risk. Transfusing even a very small quantity of the wrong blood can be fatal. Etain’s work focuses on making sure such events don’t happen. In a highly regulated discipline, it is her responsibility to oversee the service is totally compliant. “The quality framework must always be delivered to a very high specification,” she says, adding that hers is a wide brief working with multiple teams in the group, extending to ensuring the right staff are recruited, get the proper training, machines are validated and user handbooks are updated “from regulation-speak to lab-speak.”
I like to see things work
Training as a biomedical scientist, Etain started out at UCLH. It was there that she decided she preferred managing quality over working on the bench, and went to work at the Royal Free for a number of years before returning to the Group. “I’m very process-driven” she says, “I like to see things work.” Which is as well for someone overseeing compliance of a service with so many moving parts, and one that relies on logistics as much as science.
All blood is collected centrally from donors by the NHSBT service. The NHBST does not distribute the blood direct to hospitals – it all has to come through a pathology lab. The hospitals that the Group service then order it as needed directly from the blood transfusion lab.
Unlike the rest of the business, transfusion also has a large equivalent output: as fast as samples arrive for testing, units of blood are taken from the bank refrigerators and despatched to the right hospitals. “Typically, a patient’s blood sample will be taken in hospital and come to one of our labs. We then cross-match their sample – and if their procedure requires more blood, we have all their details on record which ensures they get the right match.”
The process is all highly automated – it has to be. For example, Whitfield Street looks after six hospitals’ blood needs. “Those hospitals are rapidly increasing their surgical work – but our systems can tell us when a patient is due in, what procedure they’ll have and the amount of blood they’ll need.” The system makes it as simple and efficient as it can be for hospital doctors to order the blood they need, when they need it. Part of the business is served by smart remote issue blood refrigerators; “In areas where a hospital may be some distance from a hot lab, we’ve installed a dispensing system not unlike a cold drinks machine – it means a doctor can simply enter a patient’s details and the right blood is dispensed immediately with no need to wait for a delivery.”
So, has the science around transfusion changed as rapidly as other areas of testing? “Not in about a hundred years,” says Etain. “We’re still doing the same basic test that we did in 1903 – what’s changed is the speed at which we can now do those tests.”
With the volumes of blood being processed comes a lot of valuable learning; “We have a lot of variation in patients and experience we can share. For example, the Royal Free is a liver transplant centre. Some other smaller hospitals won’t have that experience – we collate and share our learning – and we can apply what we learn to the benefit of our patients. UCH is about to become Western Europe’s largest haematology hub – so our learning about cancer and leukaemia and bone marrow transplantation will be second to none. Every type of procedure has a different need – for example, bone marrow transplants can actually change someone’s blood group. Our tests therefore have to be able to tell if someone’s blood group is changing.”
Adapting to Covid
How has the service had to adapt to Covid? “We made around 28 changes to the service to align to our hospitals’ changes and redeployment. The experience taught us a few things: first, what a great team we have – they’re so hard working and patient-centric – and the operations and scientific leads have been incredibly helpful in making sure that the service changes we made were feasible as well as compliant. Second, that our procedures and stress tests, that we apply to challenge normal service really paid off. Who really believed that, when we modelled scenarios in which 50 per cent of your workforce don’t turn up, it would really happen? It did and we got through with no impact on the quality of service because we’d done our homework.”
The team is now very involved in the management of plasma, extracted from recovered Covid patients, which is being trialled in the treatment of the disease. And, with the backlog of procedures awaiting, it’s likely that Etain’s team will be busier than ever.