Perioperative Blood Management Greg Balfanz, MD Assistant Professor - PowerPoint PPT Presentation

Perioperative Blood Management Greg Balfanz, MD Assistant Professor Department of Anesthesia UNC Hospitals

Why? 2

Why? 3

Affecting One Person 4

Affecting One Person 5

Project Aims • Primary Goal » Create and institute a standard practice for the intraoperative administration of blood products in order to decrease unnecessary blood product administration 6

Implementation • Evidence based guidelines • Expert opinion and consensus • Education and reminders • Continuous two-way feedback • Leverage existing surgical clinical pathways 7

Date range: 4/4/14-1/30/15 Date range: 10/23/15-4/15/16 8

Before vs. After Hemoglobin Trigger/Nadir Level Before After 16 Two-Sample T-test and CI 14 mean difference = 1.719 p-value < 0.001 12 Hemoglobin Level 10 UCL=9.86 8 _ X=7.04 6 LCL=4.23 4 2 1 10 19 28 37 46 55 64 73 82 Observation Project: PERIOP_BLOOD_12-8-15.MPJ; Worksheet: April-Jan_2014_Hodnett; 4/4/2016 9:16:47 AM; nwoody@aims.u

Process Sigma Calculation and Comparison UROLOGY SURGERY DATA Process Sigma Calculation BEFORE AFTER CHANGE DATE 4/4/14-1/30/15 10/23/15-4/15/16 OPPORTUNITIES (Urology Surgeries 529 326 DEFECTS (Transfusion) 76 22 DEFECTS (%) (Transfusion/Opp) 0.144 0.067 YIELD (%) 85.6% 93.3% 7.7% DPMO 143,667 67,485 (76,182) PROCESS SIGMA 2.54 2.98 0.44 TRANSFUSION RATE (%) 14.4 6.7 (7.7) REDUCTION IN TRANSFUSION -52.9% RATE 10

Financial Impact UROLOGY SURGERY DATA BEFORE AFTER DELTA DATE 4/4/14-1/30/15 (8 mths) 10/23/15-4/15/16 (6 mths) CASE VOLUME 529 326 TRANSFUSION VOLUME 76 22 TRANSFUSION RATE 14.3% 6.7% (7.6%) MEAN UNITS TRANSFUSED 3.2 Units PRBC 2.3 Units PRBC (0.9 Units PRBC) COST OF PRBC/UNIT ~$200 (per Blood Bank) ~$200 (Per Blood Bank) NUMBER OF UNITS 231 units transfused 47 units transfused (184) TRANSFUSED (Raw) ANNUALIZED NUMBER OF 347 94 (253) UNITS TRANSFUSED (Est.) ANNUALIZED COST $69,400 $18,800 ($50,600) ASSOCIATION (Est.) 11

Financial Impact ALL SURGERY DATA – MAIN OR BEFORE AFTER DELTA DATE 10/23/14-10/23/15 10/23/2014-10/23/15 CASE VOLUME 17,674 (act) 17,674 (act) TRANSFUSION VOLUME 1,308 (act) 601 (est) (-707) TRANSFUSION RATE 7.4% (act) 3.4% (est) (4%) MEAN UNITS TRANSFUSED 3.2 Units PRBC 2.3 Units PRBC (0.9 Units PRBC) (Urology Mean) (Urology Mean) COST OF PRBC/UNIT ~$200 (per Blood Bank) ~$200 (Per Blood Bank) NUMBER OF UNITS 4,173 units transfused 1,383 units transfused (2,790) TRANSFUSED (Est.) ANNUALIZED COST $834,600 $276,600 ($558,000) ASSOCIATION (Est.) 12

Lessons Learned • Education » Delays in achieving » Hearing vs. Listening (Seeing vs. Believing) • Feedback » Is it like our existing surgical clinical pathways? 13

Sustainability and Spread • Which will come first? • New periodic spot checks • Patient Safety and Quality Improvement Website • Newly developed mobile app • Who wants in next? 14