Improving efficiency of a regional stand alone bone bank
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Improving efficiency of a regional stand alone bone bank Jonathan M. Warnock . Clare H. Rowan . Helen Davidson . Ciara Millar . M. Gavan McAlinden
Received: 12 February 2015 / Accepted: 30 June 2015 Ó Springer Science+Business Media Dordrecht 2015
Abstract The introduction of a stand-alone Bone Bank in our Regional Orthopaedic Hospital has improved the availability of femoral head allograft. Benninger et al. (Bone Joint J 96-B:1307–1311, 2014), demonstrated their institutions bank to be cost effective despite a 30 % discard rate for harvested allograft. We sought to audit our own discard rates and subsequent cost-effectiveness of our bone bank. Donor recruitment. Before approaching a potential donor, our establishment’s nurse specialists review their clinical notes and biochemical laboratory results, available on a regional Electronic Care Records. They view femoral head architecture on radiographs against set criteria, Patient Archive and Communication system (SECTRA, Sweden). In total 1383 femoral heads were harvested, 247 were discarded giving an overall rate of 17.9 %. The most common reasons for discard of harvested graft was a positive microbiology/bacteriology result, n = 96 (38.9 %). After a rise in discard rates in 2007, we have steadily reduced our discard rates since 2006/2007 (28.2 %), 2008/2009 (17 %), 2010/2011 (14.8 %), and finally to 10.3 % in 2012/2013. In the current financial year, our cost to harvest, test, store and release a femoral head is £610. With a structured donor recruitment process and unique pre-operative radiographic analysis we have J. M. Warnock (&) C. H. Rowan H. Davidson C. Millar M. G. McAlinden Musgrave Park Bone Bank, Belfast, UK e-mail: [email protected]
successfully reduced our discard rates bi-annually making our bone bank increasingly cost-effective. Keywords Femoral head allograft Bone bank Discard rates Efficiency
Introduction Musgrave Park is a regional Bone Bank supplying bone to the Orthopaedic service in Northern Ireland. Over the last decade we have experienced increased demand for allograft bone, particularly for revision arthroplasty, spinal surgery and foot and ankle surgery. The bone bank is regulated by the human tissue authority and complies with the European tissue and cells directive, EUTCD (2004/23/EC). Identifying, storing and processing suitable femoral head donors is a complex process. EUTCD ensures there are rigorous standards for bone banking facilities. Compliance with the directive has financial implications when supplying femoral head allograft. Benninger et al. (2014) analysed the sustainability of their institutions bone bank. They found it to be cost effective, though it is noted that their discard rate for harvested femoral heads was 35 %. Other reported discard rates are extremely variable ranging from 12 to 46 %. (Ivory and Thomas 1993; Khan et al. 1998; Leung et al. 2010; Love et al. 2009; Nather and David 2007; Nielson et al. 2001; Saies and Davidson 1990; Stepanovic and Ristic 2014).
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