1. Julie Welbig Transfusion Safety Officer Fairview Health Services
Using Data to Improve Safety and Improve Your Patient Blood Management Program
Julie Welbig
Transfusion Safety Officer
Fairview Health Services

2. Conflict of Interest Disclosure Julie Welbig, MLS(ASCP)SBB
Has no real or apparent
conflicts of interest to report.

3. 6 Hospitals in Fairview System
Mix of teaching/academic and community hospitals
Total transfusions in system:
RBCs: ~ 30,000/year (2/3 at university hospital)
Plasma: ~ 10,000/year (over 2/3 at university hospital)
Platelets: ~ 17,000/year (almost entirely at university hospital)
Yikes! That is a lot of monitoring and data to collect!

4. Development of Databases
Data is everywhere!
Blood bank/laboratory data
Information about the transfused blood component
EHR data
Information about the patient
Information about the order
Information Technology is your best friend 
Continued improvement in the databases – don’t stop developing!
*Blood bank data is essential, and most likely starting point, but doesn’t necessarily contain the “whole picture”.

6. Blood Utilization Metrics – What data can I collect?
Total # of transfusions
% transfusions given at or below a particular hemoglobin threshold
2 unit red blood cell orders
% transfusion appropriateness/within guidelines (subjective metric)
Others?
Not talking about the metrics used in blood bank, such as outdate rate, that blood bank has control over. These are metrics of provider practice, things that the blood management group can review for performance improvement projects, etc.

7. So what did we do?
Discharge Database
Daily Transfusion Report

8. Patient Discharge Database
Originally developed as a financial tool
Available upon discharge coding of patient’s visit
Patient’s transfusion data is coupled with billing codes (DRG, ICD-9, CPT)
Semi-automated RBC transfusion audits based on ICD-9 codes (conditions that may create a greater oxygen demand)
Marks appropriate based on hemoglobin level and codes
Marks “needs review” if does not meet any of the rules
Great retrospective review of a patient’s transfusion history during their stay

9. Is the Discharge Database Enough?
Information not available until discharge (challenging if patient’s stay lasts for months)
Only includes patients that were transfused
Patient’s location/service line/provider at time of transfusion not always correct
Limitation of our LIS
RBC orders are not interfaced from EHR
Was not necessarily developed to use for targeted education, such as particular location or service line

10. Daily Transfusion Report
Developed as a more real-time report
Provides information on every transfusion in the last 24 hours
Type of transfusion
Time of issue
Patient location, service line, and attending at time of issue
Pertinent pre- and post-laboratory values
If transfusion occurred in the operating room
Name of surgery, surgeon, and anesthesiologist

11. Daily Transfusion Report cont.
Each daily report is reviewed for RBC transfusion appropriateness (largest hospital only)
Semi-automated
Rules built to mark RBC transfusions appropriate based on patient’s age, service line, and pre- and post-hemoglobin levels
Those transfusions not marked as appropriate are manually reviewed

12. Is the Daily Transfusion Report Enough?
Only includes patients that were transfused
No DRG or ICD-9 information

13. Working With the Databases – Data Combination
Create monthly, quarterly, yearly databases
Combine daily reports with discharge report
Use daily audit results for the “needs review” transfusions in the discharge
Combo approach pretty powerful tool

14. Working With the Databases – Pivot Tables
Location focused data (see next slide)
Service line focused data (see next slide)
Attending focused data
Inpatient versus outpatient versus OR focused data

15. Example of why to separate location versus service line data

16. Working With the Databases – Information Mining
Tabulate total number of transfusions
Normalize data by census or case mix index
Determine % transfusions given at or below a certain threshold
Calculate number of 2 unit orders
Monitor % appropriate transfusions

17. I have great data, now what?
Share, share, share!
Medical directors
Nursing leadership
Quality department
Administration and finance
Make the information simple to read and understand
Summarize the data
Make graphs and reports

18. Dashboards
Combined data to provide quarterly % appropriate numbers. Pivoted data to focus on transfusion locations. Allows locations to compare to each other and grand total.

19. Service Line Reports
Combined data to provide monthly metrics (total transfusions, % appropriate, # 2 unit orders) to chosen focus service lines.

20. Administration

21. Finance
Administration loves to see the money saved! More importantly, increased patient safety.

22. So, Does the Data Collection and Sharing Make a Difference???
Decreased inappropriate transfusions – cost savings
Decreased transfusion related adverse events – patient safety
Increased inter-departmental team work – trust and better relationships