Using Data to Improve Safety and Improve Your Patient

Blood Management Program

Julie Welbig

Transfusion Safety Officer

Fairview Health Services

Conflict of Interest Disclosure Julie Welbig, MLS(ASCP)SBB

Has no real or apparent

conflicts of interest to report.

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• 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!

6 Hospitals in Fairview System

• 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

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• 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?

• Discharge Database

• Daily Transfusion Report

So what did we do?

• 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

• 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?

• 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

• 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.

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• Only includes patients that were transfused

• No DRG or ICD-9 information

Is the Daily Transfusion Report Enough?

• 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

• 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

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Example of why to separate location versus service line data

Gyn

/Onc

Hem

atol

ogy

Hos

pita

list

ICU

Inte

rnal

Med

icin

e

Med

ical

IC

U

Neu

ro I

CU

Neu

rosu

rger

y

Sur

gery

Tra

nspl

ant

UU U4D

0

5

10

15

20

25

30

35

40

Total Platelet Transfusions

UR UNIT 5 PEDS

MEDSURG

UU U4A UU U4D UU U4E UU U6D

Transplant

0

5

10

15

20

25

30

35

40

Total Platelet Transfusions

• 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

• 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?

PCU 1 PCU 2 PCU 3 PCU 4 PCU 5 PCU 6 PCU 7 PCU 8 Grand Total0

20

40

60

80

100

120

% Appropriate RBC Transfusions by Location

% appropriate 2012-Q1

% appropriate 2012-Q2

% appropriate 2012-Q3

% appropriate 2012-Q4

Dashboards

Service Line Reports

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Administration

UMMC FSH FRH FNH FLK0

10

20

30

40

50

60

70

80

90 82.89

77.45

44.53

3542 36.36

76.63

42.2135

4234.13

RBC Transfusions by Length of Stay

RBC Transfusions per 1000 Patient Days 2011 RBC Transfusions per 1000 Patient Days 2012

RBC Transfusions per 1000 Patient Days 2013-Q1/Q2

Finance

UMMC FSH FRH FNH FLK$0.00

$100,000.00

$200,000.00

$300,000.00

$400,000.00

$500,000.00

$600,000.00

$533,755.03

$84,866.72

$0.00 $0.00 $10,056.32

YTD Total Estimated Financial Savings

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Decreased inappropriate transfusions – cost savings Decreased transfusion related adverse events – patient

safety Increased inter-departmental team work – trust and

better relationships

So, Does the Data Collection and Sharing Make a Difference???