Pioneering Quality Enhancement of Bone Marrow Transplantation in AI Era : First Implementation of Artificial Intelligence Driven Rescue Score for Operational Excellence in a Resource Limited Indian Center

Bone marrow transplant (BMT) centers in resource-limited Indian settings face substantial operational barriers—including workforce shortages, infection control lapses, and financial limitations—that impact care quality and outcomes. There remains an unmet need for an objective, practical framework to assess these challenges and benchmark Bone Marrow Transplant center performance. To devise and implement the RESCUE score, a uniquely designed, questionnaire-based, AI-driven scoring system, for comprehensive evaluation of transplant center quality and to correlate these scores with clinical outcomes in a diverse patient cohort. The RESCUE score is a novel, uniquely designed and first-of-its-kind scoring system, developed specifically to gauge the operational quality of transplant centers. Using an AI-driven approach, a comprehensive questionnaire was created encompassing seven critical domains: human resources, infection control, infrastructure, financial support, education, patient support, and protocol adherence. Each domain was systematically evaluated and scored from 0 (not met) to 2 (fully met), and summed for a composite score. The score was implemented in a single unit and correlated with data from 124 consecutive transplants (adults and children, allogeneic and autologous). Outcome measures included disease-free survival, engraftment efficiency, and detailed transplant-related morbidity and mortality. The center's composite RESCUE score was 10/14: staffing, infection control, and patient support each scored 1; infrastructure, education, and protocol adherence scored 2. Despite moderate operational resources, recipients achieved 99% survival and 91% disease-free status at median 11 months follow-up, with median engraftment at day 10. The RESCUE score provides a robust, questionnaire-based, AI-enabled tool to objectively rate and compare the quality of BMT centers. Its practical application supports standardized benchmarking and focused quality improvement in resource-constrained transplant programs.