Blood utilization and clinical outcomes in pancreatic surgery before and after implementation of patient blood management

Transfusion ◽  
2020 ◽  
Vol 60 (11) ◽  
pp. 2581-2590
Author(s):  
Steven M. Frank ◽  
Brian D. Lo ◽  
Lekha V. Yesantharao ◽  
Kevin R. Merkel ◽  
Caroline X. Qin ◽  
...  
Keyword(s):  
Clinical Outcomes ◽  
Pancreatic Surgery ◽  
Patient Blood Management ◽  
Blood Management ◽  
Before And After ◽  
Blood Utilization

The impact of patient blood management on blood utilization and clinical outcomes in complex spine surgery

Transfusion ◽  
2019 ◽  
Vol 59 (12) ◽  
pp. 3639-3645
Author(s):  
Mereze Visagie ◽  
Caroline X. Qin ◽  
Brian C. Cho ◽  
Kevin R. Merkel ◽  
Tymoteusz J. Kajstura ◽  
...  
Keyword(s):  
Clinical Outcomes ◽  
Spine Surgery ◽  
Patient Blood Management ◽  
Blood Management ◽  
Blood Utilization ◽  
The Impact

scholarly journals Transfusion Medicine Informatics: Analysis of User Burden from Clinical Decision Support Alerts in Promoting Patient Blood Management

2020 ◽  
Vol 154 (Supplement_1) ◽  
pp. S123-S124
Author(s):  
H C Tsang ◽  
P Mathias ◽  
N Hoffman ◽  
M B Pagano
Keyword(s):  
Decision Support ◽  
Clinical Decision Support ◽  
Blood Product ◽  
Clinical Decision ◽  
Blood Products ◽  
Blood Management ◽  
Before And After ◽  
Blood Utilization ◽  
Transfusion Ratio ◽  
Major Project

Abstract Introduction/Objective To increase efficiency of blood product ordering and delivery processes and improve appropriateness of orders, a major project to implement clinical decision support (CDS) alerts in the electronic medical record (EMR) was undertaken. A design team was assembled including hospital and laboratory medicine information technology and clinical informatics, transfusion services, nursing and clinical services from medical and surgical specialties. Methods Consensus-derived thresholds in hemoglobin/hematocrit, platelet count, INR, and fibrinogen for red blood cell (RBC), platelet, plasma, and cryoprecipitate blood products CDS alerts were determined. Data from the EMR and laboratory information system were queried from the 12-month period before and after implementation and the data was analyzed. Results During the analysis period, 5813 RBC (avg. monthly = 484), 1040 platelet (avg. monthly = 87), 423 plasma (avg. monthly = 35), and 88 cryoprecipitate (avg. monthly = 7) alerts fired. The average time it took for a user to respond was 5.175 seconds. The total amount of time alerts displayed over 12 months was 5813 seconds (~97 minutes of user time) compared to 56503 blood products transfused. Of active CDS alerts, hemoglobin/RBC alerts fired most often with ~1:5 (31141 RBC units) alert to transfusion ratio and 4% of orders canceled (n=231) when viewing the alert, platelet alerts fired with ~1:15 (15385 platelet units) alert to transfusion ratio and 6% orders canceled (n=66), INR/plasma alerts fired with ~1:21 (8793 plasma units) alert to transfusion ratio and 10% orders canceled (n=41), cryoprecipitate alerts fired with ~1:13 (1184 cryoprecipitate units) alert to transfusion ratio and 10% orders canceled (n=9). Overall monthly blood utilization normalized to 1000 patient discharges did not appear to have statistically significant differences comparing pre- versus post-go-live, except a potentially significant increase in monthly plasma usage at one facility with p = 0.34, although possibly due to an outlier single month of heavy usage. Conclusion Clinical decision support alerts can guide provider ordering with minimal user burden. This resulted in increased safety and quality use of the ordering process, although overall blood utilization did not appear to change significantly.

scholarly journals Seeking Strategies to Optimize Blood Utilization: The Preliminary Experience with Implementing a Patient Blood Management Program in a Greek Tertiary Hospital

2021 ◽  
Vol 10 (10) ◽  
pp. 2141
Author(s):  
Aimilia Tsante ◽  
Anastasia Papandreadi ◽  
Andreas G. Tsantes ◽  
Elias Kyriakou ◽  
Panagiota Douramani ◽  
...  
Keyword(s):  
Tertiary Hospital ◽  
Management Program ◽  
Transfusion Practice ◽  
Patient Blood Management ◽  
Medical Patients ◽  
Blood Management ◽  
Transfusion Threshold ◽  
Restrictive Transfusion ◽  
Implementation Period ◽  
Blood Utilization

Objectives: Our aim was to assess blood utilization after implementation of a patient blood management (PBM) program in a Greek tertiary hospital. Methods: An electronic transfusion request form and a prospective audit of transfusion practice were implemented. After the one-year implementation period, a retrospective review was performed to assess transfusion practice in medical patients. Results: Pre-PBM, a total of 9478 RBC units were transfused (mean: 1.75 units per patient) compared with 9289 transfused units (mean: 1.57 units per patient) post-PBM. Regarding the post-PBM period, the mean hemoglobin (Hb) level of the 3099 medical patients without comorbidities transfused was 7.19 ± 0.79 gr/dL. Among them, 2065 (66.6%) had Hb levels >7.0 gr/dL, while 167 (5.3%) had Hb levels >8.0 gr/dL. In addition, 331 (25.3%) of the transfused patients with comorbidities had Hb >8.0 gr/dL. The Hb transfusion thresholds significantly differed across the clinics (p < 0.001), while 21.8% of all medical non-bleeding patients received more than one RBC unit transfusion. Conclusion: A poor adherence with the restrictive transfusion threshold of 7.0 gr/dL was observed. The adoption of a less strict threshold might be a temporary step to allow physicians to become familiar with the program and be informed on the safety and advantages of the restrictive transfusion strategy.

Implementing a Health System–wide Patient Blood Management Program with a Clinical Community Approach

2017 ◽  
Vol 127 (5) ◽  
pp. 754-764 ◽  
Author(s):  
Steven M. Frank ◽  
Rajiv N. Thakkar ◽  
Stanley J. Podlasek ◽  
K. H. Ken Lee ◽  
Tyler L. Wintermeyer ◽  
...  
Keyword(s):  
Quality Improvement ◽  
Health System ◽  
Cost Savings ◽  
Management Program ◽  
Patient Blood Management ◽  
Blood Management ◽  
Community Approach ◽  
Clinical Community ◽  
Acquisition Costs ◽  
Blood Utilization

Abstract Background Patient blood management programs are gaining popularity as quality improvement and patient safety initiatives, but methods for implementing such programs across multihospital health systems are not well understood. Having recently incorporated a patient blood management program across our health system using a clinical community approach, we describe our methods and results. Methods We formed the Johns Hopkins Health System blood management clinical community to reduce transfusion overuse across five hospitals. This physician-led, multidisciplinary, collaborative, quality-improvement team (the clinical community) worked to implement best practices for patient blood management, which we describe in detail. Changes in blood utilization and blood acquisition costs were compared for the pre– and post–patient blood management time periods. Results Across the health system, multiunit erythrocyte transfusion orders decreased from 39.7 to 20.2% (by 49%; P &lt; 0.0001). The percentage of patients transfused decreased for erythrocytes from 11.3 to 10.4%, for plasma from 2.9 to 2.2%, and for platelets from 3.1 to 2.7%, (P &lt; 0.0001 for all three). The number of units transfused per 1,000 patients decreased for erythrocytes from 455 to 365 (by 19.8%; P &lt; 0.0001), for plasma from 175 to 107 (by 38.9%; P = 0.0002), and for platelets from 167 to 141 (by 15.6%; P = 0.04). Blood acquisition cost savings were $2,120,273/yr, an approximate 400% return on investment for our patient blood management efforts. Conclusions Implementing a health system-wide patient blood management program by using a clinical community approach substantially reduced blood utilization and blood acquisition costs.

scholarly journals Blood utilization in revision versus first-time cardiac surgery: an update in the era of patient blood management

Transfusion ◽  
2017 ◽  
Vol 58 (1) ◽  
pp. 168-175 ◽  
Author(s):  
Nadia B. Hensley ◽  
Megan P. Kostibas ◽  
William W. Yang ◽  
Todd C. Crawford ◽  
Kaushik Mandal ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Patient Blood Management ◽  
Blood Management ◽  
Blood Utilization ◽  
First Time

scholarly journals Sanguine: Visual analysis for patient blood management

2021 ◽  
pp. 147387162110285
Author(s):  
Haihan Lin ◽  
Ryan A Metcalf ◽  
Jack Wilburn ◽  
Alexander Lex
Keyword(s):  
Management Practices ◽  
Visual Analysis ◽  
Analysis Tool ◽  
Medical Procedure ◽  
Patient Blood Management ◽  
Blood Management ◽  
Medical Outcomes ◽  
Life Saving ◽  
Before And After ◽  
User Groups

Blood transfusion is a frequently performed medical procedure in surgical and nonsurgical contexts. Although it is often necessary or even life-saving, it has been identified as one of the most overused procedures in hospitals. Unnecessary transfusions not only waste resources but can also be detrimental to patient outcomes. Patient blood management (PBM) is the clinical practice of optimizing transfusions and associated outcomes. In this paper, we introduce Sanguine, a visual analysis tool for transfusion data and related patient medical records. Sanguine was designed with two user groups in mind: PBM experts who oversee blood management practices across an institution and clinicians performing transfusions. PBM experts use Sanguine to explore and analyze transfusion practices and their associated medical outcomes. They can compare individual surgeons, or compare outcomes or time periods, such as before and after an intervention regarding transfusion practices. PBM experts then curate and annotate views for communication with clinicians, with the goal of improving their transfusion practices. We validate the utility and effectiveness of Sanguine through case studies.

scholarly journals The 4-Year Experience with Implementation and Routine Use of Pathogen Reduction in a Brazilian Hospital

Pathogens ◽  
2021 ◽  
Vol 10 (11) ◽  
pp. 1499
Author(s):  
Roberta Maria Fachini ◽  
Rita Fontão-Wendel ◽  
Ruth Achkar ◽  
Patrícia Scuracchio ◽  
Mayra Brito ◽  
...  
Keyword(s):  
Clinical Outcomes ◽  
Inventory Management ◽  
Age Distribution ◽  
Blood System ◽  
Blood Component ◽  
Production Inventory ◽  
Before And After ◽  
Blood Utilization ◽  
Pathogen Reduction ◽  
Transfusion Reactions

(1) Background: We reviewed the logistics of the implementation of pathogen reduction (PR) using the INTERCEPT Blood System™ for platelets and the experience with routine use and clinical outcomes in the patient population at the Sírio-Libanês Hospital of São Paulo, Brazil. (2) Methods: Platelet concentrate (PC), including pathogen reduced (PR-PC) production, inventory management, discard rates, blood utilization, and clinical outcomes were analyzed over the 40 months before and after PR implementation. Age distribution and wastage rates were compared over the 10 months before and after approval for PR-PC to be stored for up to seven days. (3) Results: A 100% PR-PC inventory was achieved by increasing double apheresis collections and production of double doses using pools of two single apheresis units. Discard rates decreased from 6% to 3% after PR implementation and further decreased to 1.2% after seven-day storage extension for PR-PCs. The blood utilization remained stable, with no increase in component utilization. A significant decrease in adverse transfusion events was observed after the PR implementation. (4) Conclusion: Our experience demonstrates the feasibility for Brazilian blood centers to achieve a 100% PR-PC inventory. All patients at our hospital received PR-PC and showed no increase in blood component utilization and decreased rates of adverse transfusion reactions.

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