The Future of Transfusion Medicine at UnityPoint Health Carol Collingsworth, MBA, MT(ASCP)SC Director, Laboratory Management UnityPoint Health St. Luke s, Cedar Rapids Who are we? 2 1
Sustainability A Key System Strategy UnityPoint Health s (UPH) Laboratory Affinity Group has identified Patient Blood Management (PBM) as one of four critical initiatives to improve the quality and safety of patient care PBM has grown in interest due to concerns with: The increasing known and unknown risks of blood transfusion The rising cost of a limited resource Recent clinical trials have shown: Hemodynamically stable patients can tolerate lower Hemoglobin levels than previously thought, without any additional adverse affects Patients may have reduced morbidity and mortality with a restrictive transfusion practice Lab Affinity Group s PBM Goals Preventing unnecessary blood transfusions Assuring the transfusion of The right product At the right time In the right dose To the right patient A PBM Task Force was created in 4 th QTR 2012 to: Harmonize transfusion guidelines Support performance improvement by promoting best blood management practices 2
Initial Interventions Efforts to date have included: Analyzing Red Blood Cell (RBC) utilization by affiliate, service line, provider and patient risk Adopting the American Association of Blood Banks (AABB) evidence-based RBC transfusion guidelines (e.g. recommends adhering to a restrictive transfusion strategy (7-8 g/dl target) in hospitalized, stable patients) Disseminating educational materials (PBM White Paper and posters) Implementing Epic transfusion ordering decision support (Best Practice Alert [BPA]) Encouraging one transfusion at a time ( One and Done Campaign) Development of a UPH RBC Management toolkit has enabled tracking of key data, pre- and postimplementation of the Epic BPA in March 2014 Initial Interventions Best Practice Alerts 3
Initial Interventions Best Practice Alerts Initial Interventions Best Practice Alerts 4
Initial Interventions One and Done Education Findings to Date - Overall UPH Includes all ordering providers, Performance all APRDRGs, and all service lines Reflects Expected vs. Actual % of Inpatients (IP) Transfused Expected = % expected to be transfused based upon prior three month s data, modeled to adjust for case mix and severity of illness Actual = Actual % transfused Actual % IP transfused has decreased from 9.7% in Q2-12 to 8.1% in Q4-14 Reflects a 16.5% overall decrease in % IP Transfused 5
Findings to Date Overall UPH July 2013 March Performance 2014 April 2014 Dec 2014 Pre BPA RBC Units per Transfusion One unit = 50.19% Two unit = 47.34% Post BPA RBC Units per Transfusion One unit = 54.06% Two unit = 43.89% 7.7% increase in one unit transfusions 7.3% decrease in two unit transfusions Findings to Date Overall UPH July 2013 March Performance 2014 April 2014 Dec 2014 Pre BPA Transfusions by Hb Level Transfused at Hb 6-7 = 13.64% Transfused at Hb 7-8 = 42.77% Transfused at Hb 8-9 = 28.48% Post BPA Transfusions by Hb Level Transfused at Hb 6-7 = 20.15% Transfused at Hb 7-8 = 44.17% Transfused at Hb 8-9 = 21.14% 47.7% increase in transfusions at Hb 6-7 25.8% decrease in transfusions at Hb 8-9 6
Findings to Date Cedar Rapids Region July 2013 March 2014 April 2014 Dec 2014 Pre BPA RBC Units per Transfusion One unit = 56.56% Two unit = 41.45% Post BPA RBC Units per Transfusion One unit = 67.65% Two unit = 30.67% 16.4% increase in one unit transfusions 26.0% decrease in two unit transfusions Findings to Date Cedar Rapids Region July 2013 March 2014 April 2014 Dec 2014 Pre BPA Transfusions by Hb Level Transfused at Hb 6-7 = 9.77% Transfused at Hb 7-8 = 38.19% Transfused at Hb 8-9 = 27.87% Post BPA Transfusions by Hb Level Transfused at Hb 6-7 = 18.84% Transfused at Hb 7-8 = 37.87% Transfused at Hb 8-9 = 20.12% 48.1% increase in transfusions at Hb 6-7 27.8% decrease in transfusions at Hb 8-9 7
Findings to Date Cedar Rapids Region One and Done Campaign Initiated in August 2014 Lessons Learned Implementation across all regions of UPH presented some barriers, including: Working with multiple medical staffs at each affiliate required variations in approach Identifying a central medical staff contact for distribution of educational materials Identifying IT and analytics resources to support development of BPAs and collection / tracking of results Driving practice change at the physician level via performance metrics Elevating IT and data collection needs to drive timely outcomes 8
Lessons Learned A final outcome to note: Although we are transfusing a smaller % of inpatients, we have seen a slight increase in our average # RBC units transfused (Q4-14 expected = 2.75 vs. Q4-14 actual = 2.84) This may be attributed to providers allowing patients to reach a lower hemoglobin level before transfusing, but then transfusing greater than one unit per transfusion to bring the hemoglobin level up to desired levels will continue to track moving forward Critical Success Factors Factors to consider in your PBM journey: Recruit strong physician champions Base decisions on evidence based criteria Ensure timely and clear communication / education Recruit IT and analytics colleagues early on to enable timely development of decision support and analytics tools Develop ways to share results with all key stakeholders to drive change Celebrate success! 9
Next Steps Future PBM initiatives will include: Finalizing the RBC Epic order set to include clear transfusion indications Starting to develop usage guidelines for platelets, fresh frozen plasma and cryoprecipitate Appreciate the opportunity to share! Thank you! 10