Welcome to the Surgical Services Clinical Program!
Overview & Opportunity: National trials, evidence based literature, and Intermountain’s own internal data indicate that red blood cell transfusion practices are generally more liberal than is appropriate. Implementing a data driven physician education program, and an electronic blood ordering and tracking system has the potential to significantly reduce clinically unnecessary transfusions by 40%-80% in our system. The risks associated with transfusions range from mild fevers to death. These reactions are currently under reported, but occur in at least 1% of our patients receiving blood transfusions. Unnecessary transfusions also significantly drive up the cost of healthcare to the patient due to the expense of the blood product itself (approximately $1050/unit of blood including type and screen, blood, administration cost), additional nursing care, and the occasional need to treat transfusion reactions. Eliminating unnecessary blood transfusions saves lives, reduces complications, and reduces healthcare costs. “In patients who do not have advanced coronary artery disease, blood transfusion can probably be withheld in the presence of Hgb as low as 7 g/dL (hct of 21%)”( Hill et all, 2007).
This blood utilization project focus’ on inpatient packed red blood cell ( IP PRBC) usage including educating ordering physicians about appropriate transfusion thresholds and transfusion risks, as well as reducing the number of orders for 2 unit transfusions, decreasing transfusions for HCT greater than 22% and implementing the bar code blood administration within surgical services. In 2012 a new electronic ordering and data capturing system was built in TANDEM to capture red blood cell transfusion indications and outcomes across the system. The system also gives us verified data for feedback to ordering physicians about their individual transfusion practices. This then allows them to compare themselves to colleagues and to evidence based standards.
2013 Goal for the Surgical Services Clinical Program
Decrease the number of orders for 2 unit transfusions, decrease transfusion for HCT’s greater than 22% and implement the bar code administration process in the operating rooms. This goal excludes PCMC for the two unit transfusion and the HCT portion of this goal.
- Decrease the number of IP orders for 2 unit PRBC transfusions in the system by 25% compared to a baseline of 2011 data
- Decrease the number of IP transfusions of PRBC for HCT great than 22% by 25% across the system compared to 2011 data excluding bone marrow patients
- Implement the bar code administration of blood within the operating rooms excluding emergency release blood as well as implement the bar code blood administration process at PCMC including the operating rooms to improve the safety of blood administration in areas with the majority of product administration (IT Development work with 2 site implementation completed by end of 2nd quarter 2013 and implementation completed Dec. 31, 2013)
Entry Goal: 1 of 3
Target Goal: 2 of 3
Stretch Goal: 3 of 3
Clinical Challenges to Meet the Goal: This change in practice will impact the blood ordering practices of all physicians in the system not just those within Surgical Services. A report has been built that tracks individual physician ordering practices. The continuation of the electronic indicator/blood administration process will be based on the ability of IT to dedicate developers to complete this process.
Methodology: The Surgical Services Clinical Program will support other clinical programs, facility leadership with education, analysis and reporting of data as well as implementation where required.
Measurement Time Period: Third Quarter 2013 for transfusion measures, Dec 31, 2013 for bar code implementation.