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CPOE Reducing Inappropriate Transfusions (CRIT) Collaborative “The most cost effective opportunity to improve patient outcomes in the next quarter century will likely come, not from discovering new therapies but from discovering how to effectively deliver therapies that are known to be effective” Sean Berenholtz 2003
QI Collaborative Goals • Provide a venue for for multiple institutions to share experiences and projects surrounding blood utilization. • Utilize decision support tools to advance the adoption of evidence based practice in our institutions. • Set the framework for future collaborations using effective decision support tools.
CBC’s per patient day decreased from 1.5 to 1.0 (p=0.007) Pageler PCCM 2013
Chemistry per patient day decreased from 10.6 to 6.9 (p=0.049) Pageler PCCM 2013
Coags per patient day decreased from 3.3 to 1.7 (p=0.001) Pageler PCCM 2013
Study Benefits • Estimated cost saving of over $500,000.00/year • Decreased phlebotomy and in theory decreased iatrogenic anemia • Decreased secondary lab draws Pageler PCCM 2013
Study Limitations • A single PICU with trainees entering all orders. • Severity of illness decreased in the post-intervention period • Trend toward decreased utilization was noted in the pre-intervention period. Pageler PCCM 2013
Project Timeline 10/1/13 10/1/14 10/1/15 10/1/16 Year 1 Year 2 Year 3 Enroll CRIT affiliated institutions, IRB Install RBCT CDS tool and Validate Gather Baseline Data Build website and CRIT dashboard Early start cohort “go Live” 10/1/14 Late start cohort “go live” 4/1/15 Monitoring, Measurement, and Follow Up Conclusive Analysis and manuscript preparation
Baseline Data Data Inclusion criteria Age 1m- 18 yrs Admitted to the hospital greater than 24 hrs Total number of admissions Average pre-transfusion Hgb Transfusions Per patient day Defined as the most recent Hgb level drawn prior to transfusion Exclusion Criteria Less than 1 month More than 18 yrs Congenital heart disease Hgb SS, Thal. patients Transfusions in the OR ECMO All data should be broken down month to month starting January 2011
Next meeting Monday Monday October 28th 9:00 AM Spread the word!