Using data to improve safety and improve your patient blood management program
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Using Data to Improve Safety and Improve Your Patient Blood Management Program. Julie Welbig Transfusion Safety Officer Fairview Health Services. Conflict of Interest Disclosure Julie Welbig, MLS(ASCP)SBB. Has no real or apparent conflicts of interest to report.

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Using data to improve safety and improve your patient blood management program

Using Data to Improve Safety and Improve Your Patient Blood Management Program

Julie Welbig

Transfusion Safety Officer

Fairview Health Services


Conflict of interest disclosure julie welbig mls ascp sbb
Conflict of Interest Disclosure Management ProgramJulie Welbig, MLS(ASCP)SBB

Has no real or apparent

conflicts of interest to report.


6 hospitals in fairview system
6 Hospitals in Fairview System Management Program

  • Mix of teaching/academic and community hospitals

  • Total transfusions in system:

    • RBCs: ~ 30,000/year (2/3 at university hospital)

    • Plasma: ~ 10,000/year (over 2/3 at university hospital)

    • Platelets: ~ 17,000/year (almost entirely at university hospital)

      Yikes! That is a lot of monitoring and data to collect!


Development of databases
Development of Databases Management Program

  • Data is everywhere!

  • Blood bank/laboratory data

    • Information about the transfused blood component

  • EHR data

    • Information about the patient

    • Information about the order

  • Information Technology is your best friend 

  • Continued improvement in the databases – don’t stop developing!


Blood utilization metrics what data can i collect
Blood Utilization Metrics – What data can I collect? Management Program

  • Total # of transfusions

  • % transfusions given at or below a particular hemoglobin threshold

  • 2 unit red blood cell orders

  • % transfusion appropriateness/within guidelines (subjective metric)

  • Others?


So what did we do
So what did we do? Management Program

Discharge Database

Daily Transfusion Report


Patient discharge database
Patient Discharge Database Management Program

  • Originally developed as a financial tool

  • Available upon discharge coding of patient’s visit

  • Patient’s transfusion data is coupled with billing codes (DRG, ICD-9, CPT)

  • Semi-automated RBC transfusion audits based on ICD-9 codes (conditions that may create a greater oxygen demand)

    • Marks appropriate based on hemoglobin level and codes

    • Marks “needs review” if does not meet any of the rules

  • Great retrospective review of a patient’s transfusion history during their stay


Is the discharge database enough
Is the Discharge Database Enough? Management Program

  • Information not available until discharge (challenging if patient’s stay lasts for months)

  • Only includes patients that were transfused

  • Patient’s location/service line/provider at time of transfusion not always correct

    • Limitation of our LIS

    • RBC orders are not interfaced from EHR


Daily transfusion report
Daily Transfusion Report Management Program

  • Developed as a more real-time report

  • Provides information on every transfusion in the last 24 hours

    • Type of transfusion

    • Time of issue

    • Patient location, service line, and attending at time of issue

    • Pertinent pre- and post-laboratory values

    • If transfusion occurred in the operating room

      • Name of surgery, surgeon, and anesthesiologist


Daily transfusion report cont
Daily Transfusion Report cont. Management Program

  • Each daily report is reviewed for RBC transfusion appropriateness (largest hospital only)

  • Semi-automated

    • Rules built to mark RBC transfusions appropriate based on patient’s age, service line, and pre- and post-hemoglobin levels

    • Those transfusions not marked as appropriate are manually reviewed


Is the daily transfusion report enough
Is the Daily Transfusion Report Enough? Management Program

Only includes patients that were transfused

No DRG or ICD-9 information


Working with the databases data combination
Working With the Databases – Data Combination Management Program

  • Create monthly, quarterly, yearly databases

  • Combine daily reports with discharge report

    • Use daily audit results for the “needs review” transfusions in the discharge

    • Combo approach pretty powerful tool


Working with the databases pivot tables
Working With the Databases – Pivot Tables Management Program

Location focused data (see next slide)

Service line focused data (see next slide)

Attending focused data

Inpatient versus outpatient versus OR focused data



Working with the databases information mining
Working With the Databases – Information Mining Management Program

Tabulate total number of transfusions

Normalize data by census or case mix index

Determine % transfusions given at or below a certain threshold

Calculate number of 2 unit orders

Monitor % appropriate transfusions


I have great data now what
I have great data, now what? Management Program

  • Share, share, share!

    • Medical directors

    • Nursing leadership

    • Quality department

    • Administration and finance

  • Make the information simple to read and understand

    • Summarize the data

    • Make graphs and reports


Dashboards
Dashboards Management Program


Service line reports
Service Line Reports Management Program


Administration
Administration Management Program


Finance
Finance Management Program


So does the data collection and sharing make a difference
So, Does the Data Collection and Sharing Make a Difference???

  • Decreased inappropriate transfusions – cost savings

  • Decreased transfusion related adverse events – patient safety

  • Increased inter-departmental team work – trust and better relationships


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