Maintaining quality

Haematology services have several mechanisms and forms of support in the delivery of high-quality services for patients. Some of these are highlighted below: 

Guidelines and policies

There is national guidance produced by experts in the field, available in most areas of non-malignant haematology. This is produced through a number of professional bodies including the British Committee for Standards in Haematology (BSCH) of the British Society of Haematology, the British Society of Blood and Bone Marrow Transplantation and UK Haemophilia Centres Doctors’ Association. There is also guidance produced with other specialties, such as the Royal College of Obstetricians and Gynaecologists, as well as NICE guidance in a number of areas. These guidelines are often more widely applicable than just within the specialty (eg anticoagulation, thrombosis prevention and transfusion), reinforcing the commitment of the specialty to wider patient safety. Services produce their own local policies, which mainly mirror national guidance, to support local implementation of evidence-based practice. 

External assessment and peer review

There is a strong history of external assessment and peer review within the specialty. In addition to invited reviews of individual services undertaken under the auspices of the Royal College of Pathologists, there are specialty national peer review programmes. The long-established Triennial Audit Programme of the UK Haemophilia Centres Doctors’ Organisation and the Haemoglobin Disorders Peer Review Programme led by the UK Forum on Haemoglobin Disorders both involve external reviews of a service. Cancer services are subject to a national peer review programme and stem cell transplant services require review and accreditation by JACIE. These visits involve medical and nursing staff with expertise in the area as well as service users/carers, with a critical assessment of the service against national quality standards.

Audit and research

Clinical audit remains a core component of quality assurance in haematology. In addition to key local audits (including management of neutropenic sepsis, acute sickle cell crisis and chemotherapy waiting times), there are national audit programmes (such as the NHSBT/RCP National Comparative Audit of Transfusion), which identify national trends and allow benchmarking of centres. Recent national comparative audits have included patient blood management in surgery and red cell transfusion in palliative care.

Basic science and clinical research both have strong traditions in haematology, with growing clinical research portfolios in most centres. Over recent years, haematology services have been at the forefront of introducing new anticoagulant agents to wider clinical practice and they continue to bring a range of new disease-modifying agents to clinical use through close involvement in research.