JPAC Joint United Kingdom (UK) Blood Transfusion and Tissue Transplantation Services Professional Advisory Committee

Framework for Service Provision

Business Case for Intraoperative Cell Salvage (ICS)

If you are intending to introduce 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 introduction of an ICS service or purchase of a new cell salvage device will include some key points for consideration and inclusion shown in the UKCSAG Factsheet, Business Case Guidance. Both introduction of new service and purchase of a new device should be discussed at Hospital Transfusion Committee beforehand.

Intraoperative Cell Salvage (ICS) Policy Document

This policy document 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/Hospitals and private organisations. The updated 2016 complete policy document is available as a Microsoft™ Word® file here. 

Postoperative Cell Salvage (PCS) Policy Document

This policy document has been written as a generic policy to support the implementation and use of unwashed PCS 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/Hospitals and private organisations. The complete document, which was updated in 2016, is available as a Microsoft™ Word® file here

Quality Assurance in Intraoperative Cell Salvage (ICS) 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. This document provides guidance on the minimum recommended standards for hospitals using ICS and wishing to implement a Quality Control process. Download the PDF file here

Out of Hours Framework

This out of hours framework has been written to support organisations in the development of 24 hour Intraoperative Cell Salvage (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. The out of hours framework can be downloaded here.

Clinical Coding for ICS

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 intraoperative cell salvage (ICS) were introduced in April 2014, following a request from the UKCSAG. 

The codes are:          

  • 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 the clinical coders in your Trust are aware of and using these codes. To facilitate the process it might be helpful if someone in theatres is allocated responsibility to send a list of patients to the coders each month to identify where ICS has been used, for them to enter the data.

More information is available at http://webarchive.nationalarchives.gov.uk/+/http://www.isb.nhs.uk/documents/isb-0084/amd-10-2013/0084102013summ.pdf