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 PowerPoint PPT Presentation


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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

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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 DisclosureJulie Welbig, MLS(ASCP)SBB

Has no real or apparent

conflicts of interest to report.


6 hospitals in fairview system

6 Hospitals in Fairview System

  • 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

  • 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?

  • 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?

Discharge Database

Daily Transfusion Report


Patient discharge database

Patient Discharge Database

  • 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?

  • 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

  • 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.

  • 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?

Only includes patients that were transfused

No DRG or ICD-9 information


Working with the databases data combination

Working With the Databases – Data Combination

  • 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

Location focused data (see next slide)

Service line focused data (see next slide)

Attending focused data

Inpatient versus outpatient versus OR focused data


Example of why to separate location versus service line data

Example of why to separate location versus service line data


Working with the databases information mining

Working With the Databases – Information Mining

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?

  • 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


Service line reports

Service Line Reports


Administration

Administration


Finance

Finance


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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