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

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.

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

Meeting Agenda Introductions. Group . Discuss institutional progress on the CRIT project, and gathering baseline data.

Evidence based algorithm Adams Pediatrics 2011

Decision Support Window Adams Pediatrics 2011

Total transfusions per patient day decreased from to Adams Pediatrics 2011

The average pre-transfusion Hgb decreased in both the PICU and acute care wards Adams Pediatrics 2011

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

CDS Decreases Blood transfusions in the PICU Adams Pediatrics 2011

The Clinical Effect of CDS Is Sustainable Transfusions per patient day Adams- Unpublished

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 Proposed CRIT QI study design 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 Hematology patients 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

Baseline Data Total number of transfusions for patients that meet the inclusion criteria Hgb levels just prior to the transfusion Total number of patient days for patients that meet the inclusion criteria

Example Discharge Year-MonthBlood OrdersPatient DaysRPPD

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 X All Children’s Hospital, Florida Mercy Children’s Hospital XX Children’s Hospital Minnesota Nationwide Children’s Hospital MetroHealth, Case Western X Chldren’s Hospital of Richmond XX Rady Children’s Hospital Helen DeVos Children’s Hospital Akron Children’s Hospital Eastern Maine Medical Center X Shriners Hospitals UTHSC Santa Rosa Children’s Hospital X

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