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

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

Sep 25, 2022 320 likes •488 views

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

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Perioperative Blood Management

Greg Balfanz, MD Assistant Professor Department of Anesthesia UNC Hospitals

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Why?

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Why?

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Affecting One Person

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Affecting One Person

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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

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Implementation

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

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

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82 73 64 55 46 37 28 19 10 1 16 14 12 10 8 6 4 2 Observation Hemoglobin Level _ X=7.04 UCL=9.86 LCL=4.23 Before After Project: PERIOP_BLOOD_12-8-15.MPJ; Worksheet: April-Jan_2014_Hodnett; 4/4/2016 9:16:47 AM; nwoody@aims.u

Before vs. After Hemoglobin Trigger/Nadir Level

p-value < 0.001 mean difference = 1.719 Two-Sample T-test and CI

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Process Sigma Calculation and Comparison

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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 RATE

  • 52.9%
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Financial Impact

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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 TRANSFUSED (Raw) 231 units transfused 47 units transfused (184) ANNUALIZED NUMBER OF UNITS TRANSFUSED (Est.) 347 94 (253) ANNUALIZED COST ASSOCIATION (Est.) $69,400 $18,800 ($50,600)

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Financial Impact

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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 (Urology Mean) 2.3 Units PRBC (Urology Mean) (0.9 Units PRBC) COST OF PRBC/UNIT ~$200 (per Blood Bank) ~$200 (Per Blood Bank) NUMBER OF UNITS TRANSFUSED (Est.) 4,173 units transfused 1,383 units transfused (2,790) ANNUALIZED COST ASSOCIATION (Est.) $834,600 $276,600 ($558,000)

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Lessons Learned

  • Education

» Delays in achieving » Hearing vs. Listening (Seeing vs. Believing)

  • Feedback

» Is it like our existing surgical clinical pathways?

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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?

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