title: A benchmarking program to reduce red blood cell outdating: implementation, evaluation, and a conceptual framework.
abstract: BACKGROUND
  Benchmarking is a quality improvement tool that compares an organization's performance to that of its peers for selected indicators, to improve practice.
  
  
  METHODS
  Processes to develop evidence-based benchmarks for red blood cell (RBC) outdating in Ontario hospitals, based on RBC hospital disposition data from Canadian Blood Services, have been previously reported. These benchmarks were implemented in 160 hospitals provincewide with a multifaceted approach, which included hospital education, inventory management tools and resources, summaries of best practice recommendations, recognition of high-performing sites, and audit tools on the Transfusion Ontario website (http://transfusionontario.org). In this study we describe the implementation process and the impact of the benchmarking program on RBC outdating. A conceptual framework for continuous quality improvement of a benchmarking program was also developed.
  
  
  RESULTS
  The RBC outdating rate for all hospitals trended downward continuously from April 2006 to February 2012, irrespective of hospitals' transfusion rates or their distance from the blood supplier. The highest annual outdating rate was 2.82%, at the beginning of the observation period. Each year brought further reductions, with a nadir outdating rate of 1.02% achieved in 2011. The key elements of the successful benchmarking strategy included dynamic targets, a comprehensive and evidence-based implementation strategy, ongoing information sharing, and a robust data system to track information.
  
  
  CONCLUSIONS
  The Ontario benchmarking program for RBC outdating resulted in continuous and sustained quality improvement. Our conceptual iterative framework for benchmarking provides a guide for institutions implementing a benchmarking program.
authors.affiliation: Department of Medicine, Hamilton, Ontario.
authors.forename: Rebecca L
authors.initials: RL
authors.lastname: Barty
authors.affiliation: Ontario Regional Blood Coordinating Network (ORBCoN), Ontario.
authors.forename: Kathleen
authors.initials: K
authors.lastname: Gagliardi
authors.affiliation: Ontario Regional Blood Coordinating Network (ORBCoN), Ontario.
authors.forename: Wendy
authors.initials: W
authors.lastname: Owens
authors.affiliation: Ontario Regional Blood Coordinating Network (ORBCoN), Ontario.
authors.forename: Deborah
authors.initials: D
authors.lastname: Lauzon
authors.affiliation: Ontario Regional Blood Coordinating Network (ORBCoN), Ontario.
authors.forename: Sheena
authors.initials: S
authors.lastname: Scheuermann
authors.affiliation: Department of Medicine, Hamilton, Ontario.
authors.forename: Yang
authors.initials: Y
authors.lastname: Liu
authors.affiliation: Department of Medicine, Hamilton, Ontario.
authors.forename: Grace
authors.initials: G
authors.lastname: Wang
authors.affiliation: Department of Medicine, Hamilton, Ontario.|Department of Pathology and Molecular Medicine, McMaster University, Hamilton, Ontario.
authors.forename: Menaka
authors.initials: M
authors.lastname: Pai
authors.affiliation: Department of Medicine, Hamilton, Ontario.|Research and Development, Canadian Blood Services, Hamilton, Ontario, Canada.
authors.forename: Nancy M
authors.initials: NM
authors.lastname: Heddle
mesh_terms: D019985:Benchmarking; D001793:Blood Preservation; D004502:Education, Medical, Continuing; D017707:Erythrocyte Transfusion; D004912:Erythrocytes; D005260:Female; D006801:Humans; D008297:Male; D009864:Ontario