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 DisclosureJulie Welbig, MLS(ASCP)SBB Has no real or apparent conflicts of interest to report.

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 • 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? • 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? Discharge Database Daily Transfusion Report

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? • 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 • 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. • 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? Only includes patients that were transfused No DRG or ICD-9 information

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 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

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? • 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

Service Line Reports

Administration

Finance

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

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

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

Presentation Transcript

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