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The Business of Patient Blood Management in Adults and Pediatrics

The Business of Patient Blood Management in Adults and Pediatrics. Dominic Sanfilippo M.D. Richard Melseth Conflict of Interest Statement. Ten-Year Experience. 670 Beds (100 ICUs) Level 1 Trauma Center 1800 physicians (50 specialties) 36,000 inpatients/year Teaching Hospital

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The Business of Patient Blood Management in Adults and Pediatrics

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  1. The Business of Patient Blood Management in Adults and Pediatrics Dominic Sanfilippo M.D. Richard Melseth Conflict of Interest Statement

  2. Ten-Year Experience 670 Beds (100 ICUs) Level 1 Trauma Center 1800 physicians (50 specialties) 36,000 inpatients/year Teaching Hospital Surgery, IM, FP, OB/GYN, Ortho, Med/Ped 16 Operating Rooms Transplants Kidney, Pancreas, Liver, BMT High-Risk OB Competition for Capital $$$

  3. Key Elements of a Business Proposal • Use hospital capital planning format and process • Use SABM Business Plan resources • Align with Hospital/System Strategic Plan • Fundamentals - why, what, who, when, how? • Include proposal and business elements ~ See Handout ~

  4. Find the Opportunity – Quality and Money • Data collection on current transfusion, blood loss, lab draw practice variations • Find cost of transfusion locally • Benchmark with literature: cost savings, decrease in complications and utilization • Make case for efficient care – less cost, lower LOS, better outcomes • Align with quality initiatives of your hospital ; which are becoming national via “the commission” and CMMS – value based purchasing

  5. Quality Measures to Be Used under Medicare’s Hospital Value-Based Purchasing Program • Clinical process • AMI, heart failure, pneumonia, infections, surgery (beta blockers…) • Patient experience (communications…) • Patient mortality • Hospital-acquired conditions • Patient safety

  6. Adult Program vs. Pediatric • Pre-op Anemia Clinic value/cost savings • Decreased LOS allows more efficient use of OR and inpatient beds • Decrease transfusion cost, complications ~ See Handout ~

  7. Properly Structured Business Plan will: • Justify additional $$ resources (staff, Pre-op Surgical Assessment Clinic) • Share PBM vision w/multiple disciplines & hospital services • Ensure customer satisfaction (i.e., physician, patient and employees) • Serve as roadmap for annual evaluation & process improvements (e.g., strategic objectives)

  8. Pediatric Challenges • Smaller volumes of patients and blood • Less preoperative anemia in elective surgeries • Fear and loathing of health care reform • Competition for capital • All make revenue enhancement difficult in a performa for a Pediatric Program

  9. “Classic” Justification: in Peds not just a performa • Lower transfusion/lab incidence and cost • Decrease complications, decrease LOS, vent days, etc. • Support of surgical services, more patients • Decrease practice variation, comply with evidence based medicine • Enhance reputation of institution, innovation • Research value = quality = comparative effectiveness

  10. Pediatric Advantages • Mission driven – “what’s best for kids” • Foundation support • Recognition of research value • Support because it is important to the clinicians to improve care, impact community • Dollar, performa justification “the least important thing” to my up reports • The value of the program is beyond the initial dollar impact of transfusion thresholds, microsampling, lab frequency as it adds to our care in multifaceted ways

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