The Red Cell Dosage Calculator is an innovation conceived and designed by Dr Sharran Grey, Honorary Consultant Clinical Scientist at Bolton NHS Foundation Trust. It was inspired by her doctoral research on 'accelerated red cell transfusion' which highlighted the importance of the volume of red cell transfusion in the context of a patient’s body weight.
A baseline audit showed that only 35% of patients met their target haemoglobin level when an empirical policy of 1 or 2 units of red cells was in place, with 26% being under-transfused and 39% being over transfused.
A team of colleagues at Bolton NHS Foundation Trust (collectively known as the Transfusing Wisely Team) were involved in development of a prototype application, testing, validation, assessment of clinical effectiveness, MHRA Medical Device registration, CE marking and clinical implementation. This successful collaboration has delivered a number of benefits:
- Around 90% of patients who have red cells prescribed as per number of units recommended by the application now meet their target haemoglobin, reducing cases of over and under-transfusion
- Red cell usage was reduced by around 18% in the first year of implementation, ensuring appropriate use of donor blood and delivering cost savings
Compliance with national guidance on weight-adjusted red cell dosing:
- NICE Guideline NG24
- Serious Hazards of Transfusion Report recommendations
- National Comparative Audit of Transfusion-Associated Circulatory Overload report recommendations
- A personalised approach to aiming for 'right first time' patient blood management
The Importance of using CE marked Clinical Apps
The Royal College of Physicians advise "There are important European regulations about medical apps and you should know where you stand. A CE mark is the assurance that an app meets essential criteria, works and should be clinically safe (rather like an MOT for a car in the UK). You should not use medical apps, including web apps, that do not have a CE mark."
Technical Solutions Worldwide Ltd is a software and cyber security company that has worked closely with Bolton NHS Foundation Trust and other NHS Trusts throughout the UK over the past 20 years, and has a varied portfolio of solution-based healthcare projects.
This long-established working partnership brings together medical, scientific and software programming expertise to deliver a validated and clinically effective web application, available in a format that can be shared and obtained on a license-basis.
The Red Cell Dosage Calculator is an affordable product offered by Technical Solutions Worldwide Ltd, providing ongoing support and updates, while Bolton NHS Foundation Trust remain responsible for changes affecting clinical practice, testing, validation and ongoing regulatory compliance.
Please note that Bolton NHS Foundation Trust will remain responsible for all changes affecting clinical practice, testing, validation and ongoing regulatory compliance of the Red Cell Dosage Calculator application.
- A Web-App for weight-adjusted red cell dosing: post-development implementation and clinical effectiveness (2018). 181, (supplement 1), p. 146
- A Web-App for weight-adjusted red cell dosing: post-development implementation and clinical effectiveness (2018). – British Society of Haematology conference poster
- A red cell dosage calculator could promote single unit red cell transfusion, prevent over-transfusion and reduce red cell usage (2016). 173 (supplement 1), p.158-159
- A red cell dosage calculator could promote single unit red cell transfusion, prevent over-transfusion and reduce red cell usage (2016) – British Society of Haematology conference poster