IMPLEMENTING EVIDENCE-BASED, HEALTH SYSTEM-WIDE PATIENT BLOOD MANAGEMENT PROGRAM

Rajiv N Thakkar1;Will W Yang2;K.H.Ken Lee3;Tyler Wintermeyer4;Emily Liu4;Paul M Ness4;Patricia Wachter, MA5;Renee Demski, MSW, MBA6;Steve M Frank4 and Dr. Eric E. Howell, MD*7, (1)Johns Hopkins University School of Medicine, Baltimore, MD, (2)The Johns Hopkins Medical Institutions, Baltimore, MD, (3)School of Medicine, Armstrong Institute, Baltimore, MD, (4)Johns Hopkins Medical Institutes, Baltimore, MD, (5)Armstrong Institute for Patient Safety and Quality, Baltimore, MD, (6)Johns Hopkins Medicine, Baltimore, MD, (7)Johns Hopkins University, Baltimore, MD

Meeting: Hospital Medicine 2017, May 1-4, 2017; Las Vegas, Nev.

Abstract number: 170

Categories: Quality Improvement, Research Abstracts

Background: Blood transfusion is the most common procedure performed in US hospitals.1 The Joint Commission recently determined that transfusion is among the top five overused procedures,2 and now five societies have Choosing Wisely aims to reduce unnecessary transfusions.3Due to the added risks and cost of transfusion overuse, we implemented a health system-wide patient blood management program across all five hospitals in our health system, to promote evidence-based, data-driven improvements in blood utilization.

Methods: Across five hospitals, our health system-wide blood management efforts began in July 2014 with a multidisciplinary team (with > 37 individuals) and monthly meetings. After harmonizing transfusion guidelines, an educational campaign, data collection, dashboards, and departmental provider level reports for hemoglobin triggers were all implemented to promote evidence-based practice. The dashboards are a user-friendly, interactive, Qlikview-based (Qlik, Radnor, PA) system, that acquires data from the electronic medical record (Epic, Verona, WI), and includes “drilldown” capabilities to the individual hospital, department, and provider level – as shown in the video referenced below.4  Electronic ordersets with clinician decision support were phased in at all five hospitals for red blood cells (RBCs), plasma, and platelets. A “Why give 2 when 1 will do” campaign was launched for RBCs to encourage single unit RBC transfusions. Data were analyzed for hemoglobin transfusion triggers and the number of RBC units per order (1 vs. ≥ 2), and changes in overall blood utilization and cost savings were analyzed to compare time periods before and after the program was launched.

Results: At baseline (FY14) there was a wide variation in the percentage of RBC transfusion orders that were for ≥ 2 units among the five hospitals (Fig. 1A) (P<0.0001). The average decrease in percentage of ≥ 2-unit RBC orders among the five hospitals was 48% (P<0.0001), with the greatest decrease occurring at Johns Hopkins Hospital (58%). The average decrease in percentage of RBC units ordered out of guidelines (trigger hemoglobin ≥ 7 g/dL) among the five hospitals was 13% (P=0.008) with the greatest decrease occurring at Bayview Medical Center (34%) (Fig. 1B). Including all three major blood components, the overall changes in blood acquisition costs are shown in Fig. 1C. The total annualized cost avoidance (FY16 vs. FY14) was $1,400,339, representing a 5% decrease.

Conclusions: A health system-wide blood management program focused on evidence-based transfusion triggers and a “Why Give 2 When 1 Will Do?” campaign for RBCs has enabled us to decrease unnecessary transfusions. Our interactive data dashboards play an integral role by generating reports that compare individual providers to their peers for compliance with evidence-based transfusion guidelines.  By implementing a successful patient blood management program we can reduce risk, improve outcomes, and save cost, which in turn increases the value of healthcare delivered to our patients.

References:

1. http://www.hcup-us.ahrq.gov/reports/statbriefs/sb149.pdf

2. http://www.jointcommission.org/overuse_summit/

3. http://www.choosingwisely.org/societies/american-society-of-anesthesiologists/

4. https://youtu.be/6UhXFaYWx14              

To cite this abstract:

Thakkar, RN; Yang, WW; Lee, KHK; Wintermeyer, T; Liu, E; Ness, PM; Wachter, P; Demski, R; Frank, SM; Howell, DEE . IMPLEMENTING EVIDENCE-BASED, HEALTH SYSTEM-WIDE PATIENT BLOOD MANAGEMENT PROGRAM. Abstract published at Hospital Medicine 2017, May 1-4, 2017; Las Vegas, Nev. Abstract 170. Journal of Hospital Medicine. 2017; 12 (suppl 2). https://www.shmabstracts.com/abstract/implementing-evidence-based-health-system-wide-patient-blood-management-program/. Accessed November 20, 2019.

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