Presentation on theme: "Julie Welbig Transfusion Safety Officer Fairview Health Services"— Presentation transcript:
1Julie Welbig Transfusion Safety Officer Fairview Health Services Using Data to Improve Safety and Improve Your Patient Blood Management ProgramJulie WelbigTransfusion Safety OfficerFairview Health Services
2Conflict of Interest Disclosure Julie Welbig, MLS(ASCP)SBB Has no real or apparentconflicts of interest to report.
36 Hospitals in Fairview System Mix of teaching/academic and community hospitalsTotal 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!
4Development of Databases Data is everywhere!Blood bank/laboratory dataInformation about the transfused blood componentEHR dataInformation about the patientInformation about the orderInformation Technology is your best friend Continued improvement in the databases – don’t stop developing!*Blood bank data is essential, and most likely starting point, but doesn’t necessarily contain the “whole picture”.
6Blood Utilization Metrics – What data can I collect? Total # of transfusions% transfusions given at or below a particular hemoglobin threshold2 unit red blood cell orders% transfusion appropriateness/within guidelines (subjective metric)Others?Not talking about the metrics used in blood bank, such as outdate rate, that blood bank has control over. These are metrics of provider practice, things that the blood management group can review for performance improvement projects, etc.
7So what did we do?Discharge DatabaseDaily Transfusion Report
8Patient Discharge Database Originally developed as a financial toolAvailable upon discharge coding of patient’s visitPatient’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 codesMarks “needs review” if does not meet any of the rulesGreat retrospective review of a patient’s transfusion history during their stay
9Is the Discharge Database Enough? Information not available until discharge (challenging if patient’s stay lasts for months)Only includes patients that were transfusedPatient’s location/service line/provider at time of transfusion not always correctLimitation of our LISRBC orders are not interfaced from EHRWas not necessarily developed to use for targeted education, such as particular location or service line
10Daily Transfusion Report Developed as a more real-time reportProvides information on every transfusion in the last 24 hoursType of transfusionTime of issuePatient location, service line, and attending at time of issuePertinent pre- and post-laboratory valuesIf transfusion occurred in the operating roomName of surgery, surgeon, and anesthesiologist
11Daily Transfusion Report cont. Each daily report is reviewed for RBC transfusion appropriateness (largest hospital only)Semi-automatedRules built to mark RBC transfusions appropriate based on patient’s age, service line, and pre- and post-hemoglobin levelsThose transfusions not marked as appropriate are manually reviewed
12Is the Daily Transfusion Report Enough? Only includes patients that were transfusedNo DRG or ICD-9 information
13Working With the Databases – Data Combination Create monthly, quarterly, yearly databasesCombine daily reports with discharge reportUse daily audit results for the “needs review” transfusions in the dischargeCombo approach pretty powerful tool
14Working With the Databases – Pivot Tables Location focused data (see next slide)Service line focused data (see next slide)Attending focused dataInpatient versus outpatient versus OR focused data
15Example of why to separate location versus service line data
16Working With the Databases – Information Mining Tabulate total number of transfusionsNormalize data by census or case mix indexDetermine % transfusions given at or below a certain thresholdCalculate number of 2 unit ordersMonitor % appropriate transfusions
17I have great data, now what? Share, share, share!Medical directorsNursing leadershipQuality departmentAdministration and financeMake the information simple to read and understandSummarize the dataMake graphs and reports
18DashboardsCombined data to provide quarterly % appropriate numbers. Pivoted data to focus on transfusion locations. Allows locations to compare to each other and grand total.
19Service Line ReportsCombined data to provide monthly metrics (total transfusions, % appropriate, # 2 unit orders) to chosen focus service lines.
21FinanceAdministration loves to see the money saved! More importantly, increased patient safety.
22So, Does the Data Collection and Sharing Make a Difference??? Decreased inappropriate transfusions – cost savingsDecreased transfusion related adverse events – patient safetyIncreased inter-departmental team work – trust and better relationships