QS138 Quality Insights tool

NHS hospitals and private hospitals in England and Wales can register to use the tool.

Registration process

The stages in the registration process are:

• You will need to agree a Transfusion Practitioner (TP), or equivalent, to manage an account on behalf of your hospital. If you work in a team of TPs and / or cover multiple sites you can either set up one dedicated TP contact for all sites or have a dedicated person per hospital. You cannot use a team email to register. 
  
• The person who will manage the account contacts the QS138 Quality Insights inbox email -niceqs138@nhsbt.nhs.uk, providing the name of the hospital they want to sign up for and which Regional Transfusion Committee (RTC) the hospital belongs to.
• The QS138 Quality Insights team will check to ensure that the request is valid, for example, an account holder does not already exist for the named hospital site. Please note, accounts are set up per hospital site (not Trust / Health Board) to an assigned individual with a maximum of one registration per hospital. 
• The requestor is sent a user agreement; terms and conditions must be accepted to progress. 
• The QS138 Quality Insights team grant access and provide the information needed to set up your Snap© account, and start using the tool.   

User guide

For information about using the tool please refer to the guide here:

•  QS138 Quality Insights user guide (PDF 3037KB)

Refer to the information here for updates to the guide:

• link to Word doc Anwen to supply

How to guides

Quality statement 1: iron supplementation

• Preoperative anaemia toolkit - NHSBT Patient Blood Management (PBM)
• Iron deficiency anaemia toolkit - NHSBT PBM
• Anaemia in the Perioperative Pathway - Centre for Perioperative Care

Quality statement 2: tranexamic acid for adults having surgery in an operating theatre 

• Hospital policy of tranexamic acid to reduce transfusion in major non-cardiac surgery (TRACTION) - New England Journal of Medicine
• Implementing Updated NICE Guidance on Tranexamic Acid in Surgery: Moving from Evidence to Routine Practice - Medscape

Quality statement 3: reassessment after red blood cell transfusion 

• single unit transfusions - NHSBT PBM

Quality statement 4: patient information 

• Patient information leaflets - NHSBT PBM
• Recommendations from the advisory committee on the Safety of Blood, Tissues and Organs (SaBTO) on patient consent for blood transfusion - GOV.UK

• Blood Transfusion Education and Discussion Group (BTEDG) 39: QS138 Quality Insights: an audit tool to improve patient care and PBM - YouTube
• Patient Blood Management toolkit - NHSBT PBM
• Healthcare Quality Improvement Partnership - HQIP 
• National Comparative Audit (NCA) NICE Quality Standard QS138 audit reports - NHSBT Hospitals and Science
• National Quality Improvement (including Clinical Audit) Network (N-QI-CAN) resources to support QS138 - Ni-QI-CAN

Hospitals can assess compliance with QS138 using two complementary approaches: the National Comparative Audit (NCA) of QS138 and QS138 Quality Insights. Each method serves a distinct purpose in supporting both national benchmarking and local quality improvement.

NCA QS138

The NCA QS138 is a structured, national snapshot audit conducted approximately every 12 to 8 months.

Data is collected across participating organisations, and results are shared with hospital teams once all submissions have been completed and analysed

Findings are also incorporated into the Model Health System, a national dashboard that enables sites to benchmark performance against QS138 standards alongside a wide range of other patient pathway metrics. 

QS138 Quality Insights

QS138 Quality Insights is a flexible, self-assessment improvement tool designed to support continuous local monitoring and improvement.

Unlike the NCA, users to collect data for a specific quality statement, up to four times per year.

Hospitals input their data directly into the platform,and can track compliance in real time through tailored, benchmarking reports.

Regional reports are available, supporting collaboration and alignment across wider healthcare systems.

The tool continues to evolve based on user feedback and national audit findings, to better support hospitals in delivering evidence-based care.

How they work together

The NCA QS138 provides a periodic national benchmark, offering a snapshot of compliance at a specific point in time.

QS138 Quality Insights enables ongoing, local quality improvement between NCA cycles, helping organisations evaluate the impact of interventions and drive sustained improvements in practice.

Where available, data collected through an NCA QS138 audit can be reused within the QS138 Quality Insights tool, providing additional value by informing future quality improvement initiatives and decision-making.

Unlike the NCA, the Quality Insights tool requires data at a hospital level with a minimum of 10 cases per quality statement.

NICE QS138

In 2016 the National Institute for Health and Care Excellence (NICE) published QS138, associated with their national guideline (NG) for Blood transfusion NG24, which highlights four priority areas for improvement: 

• iron supplementation 

• tranexamic acid for adults 

• reassessment after red blood cell transfusion 

• patient information 

NICE guidance (including the quality standards) ensures the promotion of good health and good care for people who use services and are in line with the best available evidence of clinical effectiveness and cost effectiveness. 

Hospitals are expected to make efforts towards ensuring that clinical practice follows NICE guidance and quality standards, whilst this is not a statutory requirement, compliance may be assessed by the regulator and / or commissioners.  

QS138 Quality Insights

QS138 Quality Insights has been developed by the NHS Blood and Transplant (NHSBT) PBM England team with funding from the National Blood Transfusion Committee (NBTC) and NHSBT.

QS138 Quality Insights has been developed by the NHSBT PBM team with funding from the National Blood Transfusion Committee and NHSBT.  It builds on earlier work by the team and the former South East Coast RTC TP group, who together developed a quality improvement tool (endorsed by NICE) which provided the foundations for the automated version.

Health Service Journal (HSJ) Digital Awards 

Finalist in 'Driving Change through Data and Analytics' category, March 2024 - HSJ Digital Awards shortlist

National Institute for Health and Care Excellence (NICE)

NICE listed the tool as an 'Endorsed Resource' for Quality Standard QS138, May 2023.

Serious Hazards of Transfusion (SHOT)

The South East Transfusion Practitioner Group won the 2025 SHOT Symposium poster award with 'Slow and Steady Wins the rACE'. The poster showcases eight years of dedicated work to improve compliance with QS138 Quality Standard and, ultimately, enhance patient care.

Slow and Steady Wins the rACE (PDF 461KB)

British Blood Transfusion Service (BBTS)

The QS138 Quality Insights team were awarded the 2024 Bill Chaffe Unsung Hero Award