Patient blood management (PBM) has been proven to improve patient outcomes and save hospitals millions of dollars. Ensuring the quality of your data is central to decision making and critical to having a strong PBM program. Would you like to learn how your organization can improve patient outcomes by implementing a PBM program based on accurate data? If so, view this presentation by blood management expert Lance Trewhella. Lance presents how to develop a successful, evidence-based, multidisciplinary PBM program aimed at optimizing the care of patients who might need transfusion. You’ll learn: • Current recommendations for blood transfusion utilization • The impact of quality data on PBM programs • Best data practices in PBM

1. Patient Blood Management:
Impact of Quality Data on Patient Outcomes
LANCE TREWHELLA, MSN, RN
SEPT. 29, 2016

2. Lance Trewhella, MSN, RN
• Nursing Education Specialist, Rochester, Minn.
• Drove $30 million in cost savings and
improvements in patient outcomes
• Former director of AABB Patient Blood
Management program
Disclosures
• Viewics consultant
• Blood donor

3. Objectives
• Explain the concept and scope of Patient Blood Management
(PBM)
• Describe the impact of quality data on PBM programs
• Identify best data practices in PBM

4. Patient Blood Management
“Patient blood management (PBM) is an evidence-­based,
multidisciplinary approach to optimizing the care of patients who
might need transfusion. ”

5. American Hospital Association – Summary of
Recommendations
• The AHA has developed a “top five” list of hospital-­based procedures or
interventions that should be reviewed and discussed by a patient and
physician prior to proceeding:
• Appropriate blood management in inpatient services
• Appropriate antimicrobial stewardship
• Reducing inpatient admissions for ambulatory-­sensitive conditions
(i.e., low back pain, asthma, uncomplicated pneumonia)
• Appropriate use of elective percutaneous coronary
intervention
• Appropriate use of the ICU for imminently terminal illness
(including encouraging early intervention and discussion
about priorities for medical care in the context of
progressive disease

6. 6 Recommendations: Proceedings from the National
Summit on Overuse TJC & AMA, July 2013
1. Develop a tool kit of clinical educational materials for M.D.s throughout the
learning continuum, including the risks and benefits of transfusion and the
dissemination of best practices and guidelines supported by evidence.
2. Expand education on transfusion avoidance and appropriate alternatives to
transfusion. Identify subject matter experts within organizations to provide guidance.
3. Advocate for scheduled periodic assessment of prescriber competency and for
accountability to organizational standards.
4. Standardize performance metrics, data collection and vocabulary to allow valid
benchmarking within organizations. Measure individual physician transfusion
practice as part of ongoing professional practice evaluation (OPPE).
5. Develop a separate informed consent process for transfusion that communicates
the risks and benefits consistent with current evidence.
6. Identify research priorities to close evidence gaps in what constitutes optimal
transfusion practice.

7. TJC: Areas of Overuse
1. Antibiotic use for viral upper respiratory infections – develop clinical definitions for viral and bacterial upper respiratory
infections, align current national guidelines that are contradictory, partner with the U.S. Centers for Disease Control and
Prevention (CDC), and initiate a national education campaign on overuse of antibiotics for viral upper respiratory infections.
2. Appropriate blood management – develop a tool kit of clinical education
materials for doctors, expand education on transfusion avoidance and
appropriate alternatives to transfusion, and develop a separate informed
consent process for transfusion that communicates the risks and benefits.
3. Tympanostomy tubes for middle ear effusion of brief duration – develop performance measures for appropriate use of
tympanostomy tubes, determine the frequency with which tympanostomy tubes are performed for inappropriate indications
in otherwise healthy children, and focus national research on issues related to tympanostomy tubes, including the role of
shared decision making with parents and other caregivers.
4. Early-­term non-­medically indicated elective delivery – standardize how gestational age is calculated, make the early
elective deliveries indications and exclusion list as comprehensive as possible to improve clinical practice, and, educate
patients and doctors about the risks of non-­medically indicated early elective deliveries.
5. Elective percutaneous coronary intervention – encourage standardized reporting in the catheterization and interventional
procedures report, encourage standardized analysis/interpretation of non-­invasive testing for ischemia, focus on informed
consent and promote patient knowledge/understanding of the benefits/risks of PCI, and provide public and professional
education.

9. 9.1 Data Collection
The program shall provide all
data generated from the
utilization review process to
the program members for
review and analysis.
9.1.1 These data shall be
analyzed for trends across the
institution and within specific
departments or services.

10. Imagine if you could…
Know details on every transfusion
and get an answer in seconds

11. Patient Blood Management
Automated
data
management
Patient Blood
Management
= + +Education
Change
Management

12. Optimizing/maximizing care
• More testing, more treatments, more days in the hospital, etc. are
usually not in the patient’s best interest
• Optimal care involves less (blood products, LOS, complications)
• Optimizing care is not just adopting a more restrictive laboratory
value for transfusion
• Clinical practice guidelines that recommend a particular threshold
for transfusion are important, but only one consideration in the
decision-­making process

13. Best in Class: Patient Blood Management
Executive dashboard
• Blood transfusion rates
– Provider
– Time period
– Location
– Service
• Goal
• Comparison with best-­in-­class
transfusion rates
• Cumulative cost savings

14. Impactful data
Detailed analytics through peer comparisons, trends, and
compliance with hospital (national) guidelines

15. PBM Sample Dashboard – Executive
• Real-­time (daily, weekly, monthly)
• Impactful data for meaningful patient blood
management program
• Choose
– location, physician, time period, etc.
• Check transfusion by location including OR,
inpatient, outpatient, and ER
– Detailed transfusion data
• Understand individual or system-­wide trends and
practices
• Validation
– Ongoing basis
– Process for changing lab ordering numbers
– Equipment changes
– Location of transfusion

16. Patient Blood Management -­ Benefits
• Intuitive data for implementing patient blood management program
− Reduce complications
− Lower mortality rates
− Reduce length of hospital stays / costs
− Decrease total costs
• Drive appropriate blood transfusion
− Pattern and outlier detection
− Peer-­to-­peer comparison
− Convergence in practice across organization and clinicians
• Reduce manual data collection, query, and report workload
− Improve accuracy of reporting
− Reduce variation in data collection
− Identify issues with data feeds quickly

17. Expected savings with comprehensive PBM Program
For hospital with ~500 beds
10-­40% savings of total blood spend

18. Imagine if you could…
Have all of this with less than one
week of total IT/clinical time

20. Share data
Common staff area with high traffic

22. Standards for PBM
1.1.3 Program Coordinator
The program shall have a
program coordinator who is
responsible for the operational
aspects of the program.

23. Program Coordinator
2.1.1: Qualification
Personnel performing critical
tasks shall be qualified to
perform assigned activities on
the basis of appropriate
education, training, and/or
experience.

24. C-­suite support
• C-­suite share data
• Medical directors
– Nursing leadership
• All staff
– Quality/Risk department
• Simplify data
– Easy to understand data
– No explanation needed
– Adjust graphs and reports to meet needs

25. Impact of Data Collection and Sharing
• Decreased transfusions
– Improved outcomes
– Cost savings
• Decreased transfusion related complications
• Increased communication across service lines
• Blood gets to those who need it quicker
• Decreased turn around time

27. Thank you
Click to watch on-­demand webinar
https://goo.gl/dS1mwD