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Julie Welbig Transfusion Safety Officer Fairview Health Services.

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Presentation on theme: "Julie Welbig Transfusion Safety Officer Fairview Health Services."— Presentation transcript:

1 Julie Welbig Transfusion Safety Officer Fairview Health Services

2 Conflict of Interest Disclosure Julie Welbig, MLS(ASCP)SBB Has no real or apparent conflicts of interest to report.

3 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! 3 6 Hospitals in Fairview System

4 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! Development of Databases


6 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? Blood Utilization Metrics – What data can I collect?

7 Discharge Database Daily Transfusion Report So what did we do?

8 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 Patient Discharge Database

9 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 Is the Discharge Database Enough?

10 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

11 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 Daily Transfusion Report cont.

12 Only includes patients that were transfused No DRG or ICD-9 information 12 Is the Daily Transfusion Report Enough?

13 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 – Data Combination

14 Location focused data (see next slide) Service line focused data (see next slide) Attending focused data Inpatient versus outpatient versus OR focused data Working With the Databases – Pivot Tables

15 TWO CONTENT Example of why to separate location versus service line data 15

16 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 Working With the Databases – Information Mining

17 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 I have great data, now what?

18 Dashboards

19 Service Line Reports

20 20 Administration

21 Finance

22 Decreased inappropriate transfusions – cost savings Decreased transfusion related adverse events – patient safety Increased inter-departmental team work – trust and better relationships 22 So, Does the Data Collection and Sharing Make a Difference???

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