Post on 14-Apr-2017
Patient Blood Management: Impact of Quality Data on Patient Outcomes
LANCE TREWHELLA, MSN, RNSEPT. 29, 2016
Lance Trewhella, MSN, RN
• Nursing Education Specialist, Rochester, Minn.
• Drove $30 million in cost savings andimprovements in patient outcomes
• Former director of AABB Patient BloodManagement program
Disclosures• Viewics consultant• Blood donor
Objectives
• Explain the concept and scope of Patient Blood Management(PBM)
• Describe the impact of quality data on PBM programs• Identify best data practices in PBM
Patient Blood Management
“Patient blood management (PBM) is an evidence-based, multidisciplinary approach to optimizing the care of patients who
might need transfusion. ”
American Hospital Association – Summary of Recommendations
• The AHA has developed a “top five” list of hospital-based procedures or interventions that should be reviewed and discussed by a patient and physician prior to proceeding:
• Appropriate blood management in inpatient services• Appropriate antimicrobial stewardship• Reducing inpatient admissions for ambulatory-sensitive conditions(i.e., low back pain, asthma, uncomplicated pneumonia)
• Appropriate use of elective percutaneous coronaryintervention
• Appropriate use of the ICU for imminently terminal illness(including encouraging early intervention and discussionabout priorities for medical care in the context ofprogressive disease
6 Recommendations: Proceedings from the National Summit on Overuse TJC & AMA, July 2013
1. Develop a tool kit of clinical educational materials for M.D.s throughout the learning continuum, including the risks and benefits of transfusion and the dissemination of best practices and guidelines supported by evidence.
2. Expand education on transfusion avoidance and appropriate alternatives to transfusion. Identify subject matter experts within organizations to provide guidance.
3. Advocate for scheduled periodic assessment of prescriber competency and for accountability to organizational standards.
4. Standardize performance metrics, data collection and vocabulary to allow valid benchmarking within organizations. Measure individual physician transfusion practice as part of ongoing professional practice evaluation (OPPE).
5. Develop a separate informed consent process for transfusion that communicates the risks and benefits consistent with current evidence.
6. Identify research priorities to close evidence gaps in what constitutes optimal transfusion practice.
TJC: Areas of Overuse
1. Antibiotic use for viral upper respiratory infections – develop clinical definitions for viral and bacterial upper respiratory infections, align current national guidelines that are contradictory, partner with the U.S. Centers for Disease Control and Prevention (CDC), and initiate a national education campaign on overuse of antibiotics for viral upper respiratory infections.
2. Appropriate blood management – develop a tool kit of clinical education materials for doctors, expand education on transfusion avoidance and appropriate alternatives to transfusion, and develop a separate informed consent process for transfusion that communicates the risks and benefits.
3. Tympanostomy tubes for middle ear effusion of brief duration – develop performance measures for appropriate use of tympanostomy tubes, determine the frequency with which tympanostomy tubes are performed for inappropriate indications in otherwise healthy children, and focus national research on issues related to tympanostomy tubes, including the role of shared decision making with parents and other caregivers.
4. Early-term non-medically indicated elective delivery – standardize how gestational age is calculated, make the early elective deliveries indications and exclusion list as comprehensive as possible to improve clinical practice, and, educate patients and doctors about the risks of non-medically indicated early elective deliveries.
5. Elective percutaneous coronary intervention – encourage standardized reporting in the catheterization and interventional procedures report, encourage standardized analysis/interpretation of non-invasive testing for ischemia, focus on informed consent and promote patient knowledge/understanding of the benefits/risks of PCI, and provide public and professional education.
9.1 Data Collection
The program shall provide all data generated from the utilization review process to the program members for review and analysis.
9.1.1 These data shall be analyzed for trends across the institution and within specific departments or services.
Patient Blood Management
Automated data
management
Patient Blood Management
= + +Education Change Management
Optimizing/maximizing care
• More testing, more treatments, more days in the hospital, etc. are usually not in the patient’s best interest
• Optimal care involves less (blood products, LOS, complications)• Optimizing care is not just adopting a more restrictive laboratory value for transfusion
• Clinical practice guidelines that recommend a particular threshold for transfusion are important, but only one consideration in the decision-making process
Best in Class: Patient Blood Management
Executive dashboard• Blood transfusion rates
– Provider– Time period– Location– Service
• Goal
• Comparison with best-in-class transfusion rates
• Cumulative cost savings
Impactful data
Detailed analytics through peer comparisons, trends, and compliance with hospital (national) guidelines
PBM Sample Dashboard – Executive
• Real-time (daily, weekly, monthly)• Impactful data for meaningful patient blood
management program• Choose
– location, physician, time period, etc.
• Check transfusion by location including OR, inpatient, outpatient, and ER– Detailed transfusion data
• Understand individual or system-wide trends and practices
• Validation– Ongoing basis– Process for changing lab ordering numbers– Equipment changes– Location of transfusion
Patient Blood Management - Benefits• Intuitive data for implementing patient blood management program
− Reduce complications− Lower mortality rates− Reduce length of hospital stays / costs− Decrease total costs
• Drive appropriate blood transfusion − Pattern and outlier detection− Peer-to-peer comparison − Convergence in practice across organization and clinicians
• Reduce manual data collection, query, and report workload− Improve accuracy of reporting− Reduce variation in data collection− Identify issues with data feeds quickly
Expected savings with comprehensive PBM Program
For hospital with ~500 beds10-40% savings of total blood spend
Standards for PBM
1.1.3 Program CoordinatorThe program shall have a program coordinator who is responsible for the operational aspects of the program.
Program Coordinator
2.1.1: QualificationPersonnel performing critical tasks shall be qualified to perform assigned activities on the basis of appropriate education, training, and/or experience.
C-suite support
• C-suite share data• Medical directors
– Nursing leadership• All staff
– Quality/Risk department
• Simplify data– Easy to understand data– No explanation needed– Adjust graphs and reports to meet needs
Impact of Data Collection and Sharing
• Decreased transfusions – Improved outcomes– Cost savings
• Decreased transfusion related complications• Increased communication across service lines• Blood gets to those who need it quicker• Decreased turn around time