title: Déjà-vu all over again: using simulation to evaluate the impact of shorter shelf life for red blood cells at Héma-Québec.
abstract: BACKGROUND
  Since the 1970s red blood cells (RBCs) have had a rated shelf life of 42 days. Recently, studies have suggested poorer patient outcomes when older blood is transfused. However, shortening the shelf life of RBCs may increase costs and lead to greater instances of outdates and shortages.
  
  
  METHODS
  A simulation method to evaluate the impact of a shorter shelf life for RBCs on a regional blood network was developed. A network model of the production and distribution system in the province of Quebec was built and validated.
  
  
  RESULTS
  The model suggests that a shelf life of 21 or 28 days will have modest impact on outdate and shortage rates. A shelf life of 14 days will create significant challenges for both blood suppliers and hospitals and will result in systemwide outdate rates of 6.64% and shortage rates of 2.75%. The impact of a shorter shelf life for RBCs will disproportionately affect smaller and midsize hospitals.
  
  
  CONCLUSIONS
  A shelf life of 28 or 21 days is feasible without excessive increases to systemwide outdate, shortage, or emergency ordering rates. Large hospitals will see minimal impact; smaller hospitals will see larger increases and may be unable to find inventory policies that maintain both low outdate and shortage rates. Reducing the shelf life to 14 days, or lower, results in significant challenges for suppliers and hospitals of all sizes. All hospitals will see an impact on outdate and shortage rates; overall systemwide outdate rates (6% or more) will reach levels that would currently be considered unacceptably high.
authors.affiliation: Dalhousie University, Halifax, Nova Scotia, Canada. john.blake@dal.ca
authors.forename: John T
authors.initials: JT
authors.lastname: Blake
authors.forename: Matthew
authors.initials: M
authors.lastname: Hardy
authors.forename: Gilles
authors.initials: G
authors.lastname: Delage
authors.forename: Geneviève
authors.initials: G
authors.lastname: Myhal
mesh_terms: D001793:Blood Preservation; D004912:Erythrocytes / Q000502:physiology*; D006801:Humans; D011792:Quebec; D013997:Time Factors