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Advanced Lab Analytics for Patient Blood Management Programs
The document discusses advanced lab analytics for patient blood management programs, highlighting the excessive and inappropriate use of blood transfusions and associated risks. It outlines best practices for blood management programs, including evidence-based guidelines and the role of analytics in reducing unnecessary transfusions while improving patient outcomes and cost savings. Viewics Insights for Blood Management is presented as a solution to optimize blood bank resources and enhance clinical decision-making.
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Advanced Lab Analytics for Patient Blood Management Programs
- 1. Advanced Lab Analytics for Patient Blood Management Programs L. Eleanor Herriman, MD, MBA March 23, 2016
- 2. L. Eleanor J. Herriman, M.D., M.B.A. • Physician executive with 20 years of varied healthcare experience • Former faculty member at Harvard Business School’s Institute for Strategy and Competitiveness • Market research and strategy services to the pathology and laboratory industries at G2 Intelligence • Healthcare strategy consulting at Bain & Company Education • Pathology training at UCSF • Doctor of Medicine degree from Baylor College of Medicine • Presidents Scholarship with honors in Neurology, Psychiatry and Neuropathology • Masters in Business Administration from Harvard University Graduate School of Business Administration as a Baker Scholar Chief Medical Informatics Officer
- 3. Agenda • The Blood Utilization Problem • Blood Management Programs • Role of Analytics in Blood Management • Viewics Insights for Blood Management™
- 4. The Blood Utilization Problem
- 5. “Blood transfusion is far riskier than what people believe, and is responsible for billions in wasted healthcare dollars every year.” - Aryeh Shander MD, Clinical Professor of Anesthesiology, Medicine and Surgery, Icahn School of Medicine at Mt Sinai, New York
- 6. The Blood Transfusion Problem Transfusion Utilization Opportunity Past Guidelines Wrong Wide Variation in Ordering Over- utilization Creates Harm and Costs • Higher Hemoglobin (Hgb) triggers • 2 Units + Slow adoption of new guidelines Harm beyond transfusion reactions
- 7. Overutilization Problem Inappropriate Transfusions Appropriate 52% Inappropriate 48% U.S. Units Transfused (millions annually) Appropriate Inappropriate Morbidity and Mortality Impact 26% 20% 36% 56% 52% 14% 0% 10% 20% 30% 40% 50% 60% Hospital Mortality Total Mortality Rebleeding Acute Cor Syn Pulmonary Edema Bacterial Infections Source: National Blood Collection and Utilization Survey Report, DHHS;; and Tim Hannon and Rishi Sikka, Wall Street Journal, Jan 15, 2015. Source: Salpeter SR et al. The Am J of Med 127(2), Feb 2014
- 8. Variation in Transfusion Usage – 345 Hospitals 8 $1M in savings per hospital for joint replacement transfusions
- 9.
- 10. “A Restrictive Blood Transfusion Approach is Best Practice” - Society for the Advancement of Blood Management Standard guidelines transfusion trigger = 6-7 g/dl Higher threshold guidelines for transfusion = 7-10 g/dl The American Board of Internal Medicine’s Choosing Wisely campaign had every organization submit five “do nots” Number (3) states: “Avoid transfusion of red blood cells for arbitrary hemoglobin or hematocrit thresholds in the absence of symptoms of active coronary disease, heart failure or stroke.”
- 11. 3 Types of Blood Management Programs • Multidisciplinary Team • Decision support • Feedback/reports • Cross-facility • Anemia and hemostasis management • Transfusion management • Informatics • Patient-centered 1. Restrictive Guidelines • Hgb of 7 • “One & Done” 2. Restrictive Blood Program 3.Patient Blood Management
- 12. Joint Commission PBM Certification What’s in it for my hospital? • Risk reduction in fewer adverse events and incidents • Improved patient outcomes • Reduced hospital stays, readmissions, and lengths of stay • Ensuring blood availability for those most in need • Optimized care for those who may need transfusion • Fostering collaboration throughout the hospital • Providing a competitive edge in the marketplace • Enhanced staff recruitment and development • Cost savings Blood Management Program Success • Implementation of an anemia management program that resulted in a reduction of red blood cell transfusion by 62% • A 25% reduction in hospital stays for non-transfused vs. transfused patients • A 47% reduction in the odds of death and 50% reduction decrease in total hospitalization costs after cardiac surgery • A hospital’s first year of implementation expenses for blood decreased $510,000
- 13. Benefits of Reducing Transfusion Overutilization Cost Savings from 30% Reduction in Transfusion of Blood Products Improved Outcomes from 30% Reduction in Transfusion of Blood Products Source: National Blood Collection and Utilization Survey Report, DHHS;; and Tim Hannon and Rishi Sikka, Wall Street Journal, Jan 15, 2015. 0 0.5 1 1.5 2 2.5 3 Low End Estimate of Savings High End Estimate of Savings U.S. Savings from Blood Costs ($B annually) 50,000 lives saved 200,000 wound complications averted 8M fewer patient in-hospital days $1.5B $2.5B
- 14. Transfusion Savings for Hospitals $250 $1,000 $7,055 $0 $1,000 $2,000 $3,000 $4,000 $5,000 $6,000 $7,000 $8,000 Costs per Unit Additional Hospital Costs for Transfused vs. Nontransfused Patient Acquisition Transfusion LOS, Hospital-acquired complications, Mortality
- 15. Source: G2 Intelligence Adverse Event Decrease in AE Due to New Guidelines Rebleeding 36% Acute Coronary Syndrome 56% Pulmonary Edema 52% Bacterial Infections 14% Decrease in % of AE’s Resulting from New Restrictive Transfusion Guidelines Hospital Size 400-500 Beds Cost Savings $$ Rebleeding $131,721 $60,592 Acute Coronary Syndrome $455,544 $255,105 Pulmonary Edema $1,101,120 $572,582 Bacterial Infection $989,333 $138,507 Total $2,677,719 $1,026,786 Costs and Savings Per AE for Mid-Size Hospitals in 2011
- 16. Premier Healthcare’s Recommendations Source: “Best Practices in Blood Utilization.” October 2012. Premier Healthcare Alliance. 1. Using a multi-disciplinary blood stewardship team 2. Working collaboratively with clinicians and supply chain executives to explore alternative products and procedures 3. Establishing and implementing evidence-based transfusion guidelines 4. Providing education and clinical decision support tools to inform clinicians of guidelines in real time 5. Developing processes to monitor adherence to guidelines and provide feedback to clinicians 6. Monitoring utilization on an ongoing basis while measuring the impact of improvement requires analytics
- 17. Department Position/Specialty Total No. Representatives Hospital Administrator Chief Medical Officer 1 Blood Bank Director Laboratory Manager 2 Blood Vendor Director 1 Pathology Director 1 Pathology Residents 1+ Biomedical Engineering 1 Pharmacy 1 Risk Management 1 Clinical Services 14 (1 Physician + 1 Nurse from each specialty) Anesthesia Emergency Medicine Surgery Cardiothoracic Intensive Care Units Trauma Medicine/Hematology Pediatrics/Neonatology Nursing Nursing 3 Perioperative Nursing Nursing Education Total 26+ Model for Transfusion Committee Membership
- 18. Case Study: UPMC’s Total Blood Management Program Implement Evidence-based Transfusion Triggers Clinician CPOE Alerts Monthly Utilization Reports Minimize Preop Autologous Donation Preop Anemia Optimization Intraop POC Hgb Testing
- 19. Role of Analytics in Blood Management
- 20. Analytics for Blood Management – Key Uses Blood Bank Operations • Inventory management • Productivity • Acquisition and waste Clinical Utilization Analytics • Peer comparisons / reports • Pattern and outlier detection • Manager dashboards Decision Support / Alerts • Link transfusion decisions to prior Hgb levels • More complex rules by clinical setting • Early identification of anemic patients before elective surgeries Monitor Blood Use • By patient, clinician or service line • Real-time and by any time range • Measure impact of programs
- 21. Blood Program Analytics Capabilities 1. Link required data sources – blood, lab, clinical 2. Automates analytics with minimal labor 3. Supports multi-disciplinary program / users 4. Delivers in real–time
- 22. Case Study: UPMC’s Total Blood Management Program
- 23. Analytics for Pre-op Anemia Management • When patient is scheduled in the system for elective surgery, computer searches for most recent hemoglobin • If patient is anemic, preoperative anemia alert goes to surgeon and PCP • Identifies anemic patients before surgery & sends automated email or fax to surgeon/PCP • Allows physician to treat anemia before surgery • Shown to reduce transfusion rates
- 24. Viewics Insights for Blood Management™
- 25. Viewics Insights for Blood Management ™ Analytic Visualizations, Dashboards, Alerts Blood Bank Operations • Inventory management • Productivity • Acquisition and waste Clinical Utilization Analytics • Peer comparisons / reports • Pattern and outlier detection • Manager dashboards Decision Support / Alerts • Link transfusion decisions to prior Hgb levels • More complex rules by clinical setting • Early identification of anemic patients before elective surgeries Monitor Blood Use • By patient, clinician or service line • Real-time and by any time range • Measure impact of programs
- 26. Viewics Blood Product Waste Management
- 27. Inventory Management –Track Product Availability
- 28. Blood Bank Supply Management
- 29. Physician Variation in Blood Utilization Within One Medical Unit Percent of Patients With Transfused RBCs (# Units / Patients)
- 30. Physician Variation in Blood Utilization Across Hospital Units Percent of Patients With Transfused RBCs by Hospital Unit
- 31. Physician Blood Utilization Variation Over Time Percent of Patients with Transfused RBCs
- 32. Utilization Management by Hemoglobin Guidelines
- 33. Summary • Excessive transfusion utilization is a widespread problem, associated with high rates of morbidity, mortality and avoidable spending • Evidence-based restrictive guidelines and blood programs can change clinician usage patterns and generate significant clinical value • Analytics systems employing blood bank, lab and clinical data are critical to successfully implementing these blood programs • Viewics Insights for Blood Management™ represents one such solution – Optimization of blood bank resources – Interventions for physician utilization
- 34. Want to follow up? Contact Dr. Eleanor Herriman eleanor.herriman@viewics.com Download the recording Click here or visit goo.gl/pZZZQ4 34
Editor's Notes
- #2 • No images on this slide
- #3 physician executive with 20 years of varied healthcare industry experience. Before joining Viewics, Eleanor was a faculty member at Harvard Business School’s Institute for Strategy and Competitiveness. Other prior career experience includes: market research and strategy services to the pathology and laboratory industries at G2 Intelligence (a Plain Language Media business), healthcare strategy consulting at Bain & Company, and multiple start-up medical technology ventures. Dr. Herriman holds a Doctor of Medicine degree from Baylor College of Medicine and was awarded the Presidents Scholarship with honors in Neurology, Psychiatry and Neuropathology. Dr Herriman also holds a Masters in Business Administration from Harvard University Graduate School of Business Administration as a Baker Scholar and a Bachelors of Science in electrical engineering from Rice University, Magna Cum Laude with a minor in bioengineering.
- #6 Efficacy of blood products first questioned – NEJM, 1999 Currently 20+ clinical trials showing “less is more” in saving lives and improving outcomes
- #8 AMA and Joint Commission cited Transfusions as one of Top 5 most overused medical interventions
- #21 Preop Anemia management (tranexamic acid)
- #26 Viewics Insights for Blood Management™ provides a suite of analytics tools that enable laboratorians to play a critical, value-generating role in blood management programs. These Insights include a complete toolkit for managing blood-bank resources, as well as analytics enabling blood product utilization measurement, guideline support and tracking by clinician, service line, hospital unit and setting.