CPOE Reducing Inappropriate Transfusions (CRIT) Collaborative “The most cost effective opportunity to improve patient outcomes in the next quarter century will likely come, not from discovering new therapies but from discovering how to effectively deliver therapies that are known to be effective” Sean Berenholtz 2003

Introduction of Collaborative Participants CONTACTINSTITUTION Richard Chang, Geetha Puthenveetil Children’s Hospital Orange County Suresh SrinivasanChildren’s Hospital of Michigan Marvin Harper, Jenifer LightdaleChildren’s Hospital Boston Eloa Adams, Chris LonghurstLucile Packard Children’s Hospital Munirah Curtis, Sara Boblick SmithUniversity of Illinois at Chicago Calvin PopovichAll Children’s Hospital, Florida Phil Spinella Washington University, St Louis Rod Tarrago, Judy ZeirChildren’s Hospital Minnesota David RichNationwide Children’s Hospital David KaelberMetrohealth, Case Western Marissa Tucci CHU Sainte-Justine Research Center

Introduction of Collaborative Participants CONTACTINSTITUTION Colin Banas, Sean McKenna Children’s Hospital of RIchmond Lejla Music-AplencMercy Children’s Hospital Nabil HassanHelen DeVos Children’s Hospital Cynthia KaelbsRady Children’s Hospital Amy ManekerAkron Children’s Hospital Adam CampbellShriners Hospitals Irwin Gross Eastern Maine Medical Center Robert MoserCatholic Health East Meghan DelaneySeattle Children’s Melissa Frei-JonesUTHSC Santa Rosa Children’s Hospital Jim Fackler Johns Hopkins

Meeting Agenda CRIT Goals Adult Algorithm Oncology Patients PCORI CRIT

Old Way Publication and presentation Integration Clinical practice Publication and presentation Collaborative Integration using CDS Clinical practice New Way 5-15 years 1-2 years

QI Collaborative Goals Provide a venue for for multiple institutions to share experiences and projects surrounding blood utilization. Utilize decision support tools to advance the adoption of evidence based practice in our institutions. Set the framework for future collaborations using effective decision support tools.

Adult CDS Tool Thanks to Irwin Gross, Eastern Maine Medical Center, and Bob Moser, Catholic Health East. 1) Is BP < 90 mm Hg (or 100 mmHg); if yes, rule does not fire 2) If BP is > 90 mm Hg, is the BP > 20 mm Hg LOWER than any SBP in the prior 6 hours; if yes, rule does not fire. 3) If BP > 90 AND is greater than the highest SBP in the last 6 hours minus 20 mm Hg, then rule fires alerting provider that transfusion does not meet guidelines

Oncology Patients The problem- COG protocols have variable transgusions thresholds – Are these suggestions or potential protocol violations?? The solutiuon- Insert language into CDS tool that exclude patients in COG protocols where transfusion thresholds are >7 gm/dl

Patient Centered Outcomes Research Institute Timeline Letter of Intent Feb 15th Application deadline April 15th Awards announced September Start October 2013

Year 1Year 2Year 3 10/1/1310/1/1410/1/1510/1/16 Enroll CRIT affiliated institutions, IRB Install RBCT CDS tool and Validate Gather Baseline Data Early start cohort “go Live” 10/1/14 Late start cohort “go live” 4/1/15 Monitoring, Measurement, and Follow Up Conclusive Analysis and manuscript preparation Project Timeline Build website and CRIT dashboard

Baseline Data Inclusion criteria Age 1m- 18 yrs Admitted to the hospital greater than 24 hrs Exclusion Criteria Less than 1 month More than 18 yrs Congenital heart disease Hgb SS, Thal. patients Transfusions in the OR ECMO Data Total number of admissions Average pre-transfusion Hgb Transfusions Per patient day Defined as the most recent Hgb level drawn prior to transfusion All data should be broken down month to month starting January 2011

Institution Committee Approval ITBaseline Data IRBCDS LiveRandomized Analysis Children’s Hospital Orange County XXXX Children’s Hospital of Michigan Children’s Hospital Boston XX University of Illinois at Chicago XX All Children’s Hospital, Florida Mercy Children’s Hospital XX Children’s Hospital Minnesota XXXXX Nationwide Children’s Hospital MetroHealth, Case Western X Chldren’s Hospital of Richmond XX Johns Hopkins Children’s National Medical Center Akron Children’s Hospital Eastern Maine Medical Center XX Shriners Hospitals University of Washington in St. Louis XXX Seattle Childrens Hospital XXX

Next meeting Monday Monday August 26 th 9:00 AM Spread the word!