Framework for service provision

Intraoperative cell salvage

Business case

If you are intending to introduce intraoperative cell salvage (ICS), a business case will be required to support your proposal. While every organisation will have its own format for writing a business case, a good starting point might be the NHS National Innovation Centre who provide a detailed Template Business Case.

The case for the introduction of an ICS service or the purchase of a new cell salvage device will include some key points for consideration and inclusion shown in the UK Cell Salvage Action Group (UKCSAG) factsheet Business Case Guidance (PDF 160KB). Both the introduction of new service and the purchase of a new device should be discussed at Hospital Transfusion Committee beforehand.

Policy document

The ICS policy document (DOC 3.95MB) was updated in 2016. It has been written as a generic policy to support the implementation and use of ICS within organisations. It has been designed with the intention that it can easily be adapted to accommodate the local policies and practice of individual NHS Trusts, Boards, Divisions and hospitals, and private organisations.

Quality assurance (QA) guidance document

Is it acknowledged that all ICS manufacturers provide information on the quality of the end product. ICS devices should be properly maintained and serviced in line with the manufacturers' recommendations to ensure the post-wash quality of the salvaged blood. The ICS QA guidance document (PDF 408KB) provides guidance on the minimum recommended standards for hospitals using ICS and wishing to implement a Quality Control process.

Out of hours framework

The ICS out of hours framework (PDF 99KB) has been written to support organisations in the development of 24 hour ICS services where appropriate. It provides an overview of the different options of delivering an out of hours ICS service. Hospitals may elect to use one of these methods, a combination, or adapt a method to meet the specific needs of their organisation.

Clinical coding for intraoperative cell salvage

The OPCS-4 Classification of Interventions and Procedures is a statistical classification for clinical coding of hospital interventions and procedures undertaken by the NHS. It is an approved NHS Fundamental Information Standard. The classification is mandatory for use by healthcare providers to support various forms of data collections for operational and secondary uses.

When a patient is discharged, a clinical coder working in the hospital translates their care into codes using two classification systems – ICD-10 for diagnoses and OPCS-4 for interventions.

Two new clinical codes related to ICS were introduced in April 2014, following a request from UKCSAG:

• X36.4 – Autologous blood salvage
  Use if ICS is set up for the patient.
• X33.7 – Autologous transfusion of red blood cells
  Use if blood is actually returned to the patient.

Please ensure that clinical coders in your Trust are aware of these codes and are using them. To facilitate the process, it might be helpful if someone in theatres is allocated responsibility to send a monthly list of patients to the coders, identifying where ICS has been used so the data can be entered.

More information is available in Summary of Changes OPCS-4.6 to OPCS-4.7 (PDF 109KB).

Postoperative cell salvage

Policy document

The postoperative cell salvage policy document (DOC 2.98MB) was updated in 2016. It has been written as a generic policy to support the implementation and use of unwashed postoperative cell salvage within organisations. It has been designed with the intention that it can easily be adapted to accommodate the local policies and practice of individual NHS Trusts, Boards, Divisions and hospitals, and private organisations.