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

1. Using Data to Improve Safety and Improve Your Patient Blood Management Program Rhonda Pierson, BS ChE, MT (ASCP) Data Analyst, EMMC Patient Blood Management Program

2. Conflict of Interest Disclosure Rhonda Pierson, BS ChE, MT Data Analyst I have no real or apparent conflict of interest to report

3. EMMC Patient Blood Management Program EMMC is a 411 bed hospital in Bangor Maine PBM program started in April 2007 Medical Director Prospective review by Blood Bank Technologist Review of pre transfusion lab values prior to transfusion CPOE order entry - November 2007 In 2008 a PBM coordinator joined the program Preoperative Anemia Management

5. Live Demo Excel 2013 Data Model Red cell transfusion reports Orthopedic Surgery reports

6. Patient Blood Management Metrics Extraction programs were written by IS to extract patient information and transfusion testing by product transfused or procedure Patient demographics Pre and post transfusion testing Product transfusion time Product unit number Laboratory results for patient encounter Procedures Medications Anemia management preop treatments Anemia management preop testing

7. Patient Blood Management Metrics • Red Cell metrics are monitored and evaluated on a monthly and quarterly basis for all red cell transfusions • Hospital wide • Total units transfused • Pre /Post Transfusion HGB • Percent Single Unit Transfusions • Percent of Inpatients Transfused • Based on patient admissions • Hospital wide • Service Specific • Surgical • EMIC - Inpatient hospitalist • Orthopedics

8. Patient Blood Management Metrics • Quarterly Reports • Product Specific Report Cards • Service and Physician Specific • Red Cells • Pre /Post Transfusion HGB • Percent Single Unit Transfusions • Percent SUT with second unit within 24 hours • Units per Transfused Patient • Percent of Transfusions with HGB > 8

9. Patient Blood Management Metrics • Platelets • Pre /Post Transfusion Platelet Count • Percent of Transfusions with PLT CT > 50,000 • Frozen Plasma • Pre /Post Transfusion INR • Percent of Transfusions with INR < 1.8 • Cryoprecipitate • Pre /Post Transfusion Fibrinogen • Percent of Transfusions with Fib > 150 These reports are reviewed by the PBM Medical Director and distributed to the Chiefs of Service. Many services include the reports as part of the physicians’ performance evaluation

10. Preoperative Anemia Management Metrics Procedure Specific Quarterly Report Cards Physician Specific Preoperative HGB Admit HGB Discharge HGB Pre Transfusion HGB Post Transfusion HGB Percent of Patients Transfused (by procedure, service and provider)

11. Preoperative Anemia Management Metrics Percent of surgical patients screened Percent of surgical patients treated prior to surgery with the new data model: Tie Anemia Management preop treatment intervention to patients with red cell transfusions

12. Improve your PBM Program with Analytics Monitor transfusion practices with monthly metrics Reduce transfusion practice variability Identify Service Lines / Physicians that could benefit from PBM education and intervention Monitor preoperative Anemia Management outcomes Identify Service Line/Procedure(s) that would benefit patients with Anemia Management Identify transfusion best practices by procedure / surgeon

13. Improve Patient Outcomes with Analytics Minimize patient exposure to transfusion Evaluate the appropriateness of transfusions before they happen Prospective Review of all transfusions based on pre transfusion testing Preoperative Anemia Management Decrease in transfusions Higher admission and discharge HGB Shorter Length of Stays

20. In Conclusion: • Data is critical to drive change in transfusion practice • Change results in better transfusion decisions • Better transfusion decisions results in appropriate transfusions • Appropriate transfusions results in reduced risk to patients • Reduced risk to patients results in improved patient safety