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 Brian HobermanKaiser Northern California Melissa Frei-JonesUTHSC Santa Rosa Children’s Hospital

Collaborative Goals Provide a venue for for multiple institutions to share experiences and projects surrounding blood utilization. Test the hypothesis that CPOE tethered to CDS can improve and hasten the adoption of evidence based guidelines across multiple institutions. Set the framework for future collaborations using effective decision support tools.

Meeting Agenda A YEAR IN REVIEW – COLLABORATION- DATA AND EXPERIENCE – PROJECT DEVELOPMENT PLANS FOR THE FUTURE

A great divide exists between publications and practice General

CDS Effectively Decreases Transfusions Adams Pediatrics fewer red blood cell transfusions 100 fewer patient exposures Direct cost savings of more than $160,000.00

CDS Decreases Blood Transfusions on the Acute Care Wards Adams Pediatrics 2011

BLOOD NET – It’s an Offer You Can’t Refuse

Impact of a PRUDENT © Red Blood Cell Strategy In Children Undergoing HSCT

The Value of Working Together: Collaborating for Accelerated Improvement Paul Sharek, MD, MPH Medical Director, LPCH Center for Quality and Clinical Effectiveness Chief Clinical Patient Safety Officer Associate Professor of Pediatrics, Stanford Univ SOM

WUSM Blood Conservation Phlebotomy Reduction Techniques Project CRIT Collaborative Meeting 6/25/2012 Jennifer York, MD Washington University in St. Louis

Percent Volume Blood Overdraw by Patient Weight Blood Conservation: Identifying Factors to Reduce Phlebotomy Induced Blood Loss in the PICU Stacey Valentine MD MPH Boston Children’s

All centers “go live” with rule around the same date, running in the background. Cohort randomized to early start date Data anlayzed in three phases lasting 4 months each Initiation phase, mid phase, late phase Cohort randomized to late start date (4 months after early start date) Data analyzed in three phases lasting 4 months each Initiation phase, mid phase, late phase Begin Data Collectiopn Primary- Pre-tx Hgb Secondary Tx/pt day, Alert frequency Data Collection 1 year CRIT study design Jennifer Lightdale, Hongyu Xu InitiationMiddle Late InitiationMiddle Late Early Cohort Late Cohort

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 XX 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 XXXX Nationwide Children’s Hospital MetroHealth, Case Western X Chldren’s Hospital of Richmond XX Rady Children’s Hospital Children’s National Medical Center Akron Children’s Hospital Eastern Maine Medical Center XX Shriners Hospitals UTHSC Santa Rosa Children’s Hospital XX Seattle Childrens Hospital

Project Timeline Transfusion -IT Approval September 2011 IRB Approval October 2011 Baseline Data November 2011 Install CDS Tool November 2011 Early Cohort January 2013 Late cohort March 2013 Project Completion March 2014

GOALS Gather baseline data!! $?$?$?$?$? No Funding? Extramural funding Funding through collaborative membership Addition of adult centers Catholic Health East Kaiser Permanente

Next meeting Monday Monday October 29 th 9:00 AM Spread the word!