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Reducing Blood Transfusion Risk and Costs with Advanced CDS

  • Steven Shaha, Ph.D., DBA
  • 03/20/2012

 

Results of transfusion program at Hospital for Special Surgery, New York City

Healthcare isn’t broken, as some would have you believe.  In fact, healthcare has never been in better health than when clinical decision support (CDS) helps expert providers do the best thing, consistently.  Everyone wins – providers, patients and the healthcare organizations in which they co-operate.  Rather than criticize, perhaps we should promote more powerfully enabled models for helping.

Here’s a great example.

Few outside the inner circle of blood banks and surgeons know that the costs and risks associated with everyday blood transfusions are significant.  A recent study in the journal Transfusions pegged the cost at between $522 and $1,183 per unit of blood.  And despite the routine nature of transfusions, the procedure carries sobering and serious clinical risks.  According to The Strategic Healthcare Group, the leading causes of transfusion-related morbidity and mortality are unrelated to viral transmission and include bacterial contamination of platelets (1:2000- 3000 transfusions), transfusion errors from patient misidentification (1:16,000- 19,000), transfusion related acute lung injury (TRALI) (1:1000- 5000) and transfusion associated circulatory overload (TACO) (1:350).

In light of these and other troubling statistics, healthcare organizations are under increasing pressure to prudently use blood. Like chemotherapy, blood transfusions can improve outcomes but only when used in the right patient for the right indication and in the right dose.

Fortunately, some leading provider organizations are leveraging technology to improve their transfusion practices. Healthcare Informatics recently recognized The Hospital for Special Surgery (HSS) in New York City for a program that improved the safety and cost-efficiency of transfusions there.  HSS is nationally ranked No. 1 in Orthopedics, No. 2 in Rheumatology, and No. 19 in Neurology in U.S. News & World Report‘s “America’s Best Hospitals” 2011-12 issue. The hospital’s multi-faceted approach included research in best-practice and evidence-based medicine, education of orderers and Electronic Health Record (EHR)-delivered risk assessments, alerts and order sets. HSS leveraged its Sunrise EHR to help ordering clinicians and surgeons consider lower transfusion models of care.  The technology initiative was accompanied by education for surgeons regarding up-to-date transfusion practices and models.

To maximize the impact of the transfusion initiative, HSS focused on studying the impact on the four most blood-intensive routine surgeries, including revisions for knees and hips, and complex spine surgeries. The hospital’s highly expert physicians perform over 1,600 of these complex surgeries every year.

The impact of HSS’s innovation proves the efficacy of advanced clinical decision support (CDS) technology on impacting real patient care, provided by expert and highly-trained physicians, within complex, busy settings.  The results provide a road map for any organization evaluating alternative EHRs, or seeking to maximize the impact of EHR investments and physician adoption.

Results: Reduced patient risk, $14 million in annual savings

The HSS transfusion initiative reduced risk to patients, as well as risk-associated exposure for ordering physicians and surgeons.  The hospital estimates it saved conservatively between $5 million and $14 million annually in transfusion-related costs alone.  All this was accomplished with improved physician satisfaction scores regarding the EHR and its use for making best decisions.

The results verify a statistically significant decrease in autologous RBC transfusion rates from pre- to post-implementation, as well as a statistically significant trend in decreased use (see figure).   Cumulative mean transfusion rates across the three classes of transfusion tracked fell significantly from pre- to post-implementation (p<.001).  Results showed significant reductions in blood per surgery.  First wave impacts showed reductions of 22.5 percent, and longer-term reductions showed decreased mean cumulative transfusions rates from 8.5 units pre-implementation to 3.5 units (58.8 percent, p<.0001).  A reduction of 68.8 percent was established from highest to lowest months within the study.  The greatest decrease was in Autologous-RBC from 4.9 to 3.25 (34.8 percent, p<.0001), while decreases or non-increases were found for the other three major types or transfusions quantified. 

Multiplying these means by documented cost figures from the literature established savings in transfusions costs alone of between $5.23 million and $14.08 million annually for the organization. HHS’s success illustrates the impact every healthcare organization  can have if they leverage technology atop culture and training and ongoing learning for their clinicians.  The combination is unbeatable – technology enables organizational change and empowers expert clinicians.  Advanced clinical decision support is the key to the ills we face as a healthcare system. 

Question: How has your organization used technology to improve health outcomes?  I’d love to hear what you’ve been up to …

 

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About the author

Steven H. Shaha, Ph.D., DBA, is a Professor at the Center for Policy & Public Administration, and the Principal Outcomes Consultant for Allscripts. Dr. Shaha received his first doctorate in Research Methods and Applied Statistics from UCLA and has taught and lectured at universities including Harvard, University of Utah, UCLA, Princeton, Cambridge and others. An internationally recognized thought leader, lecturer, consultant and outcomes researcher, Dr. Shaha has provided advisory and consulting work to healthcare organizations including the National Institutes for Health (NIH), and to over 50 non-healthcare corporations including RAND Corp, AT&T, Coca-Cola, Disney, IBM, Johnson & Johnson, Kodak, and Time Warner. Dr. Shaha has presented over 200 professional papers, has over 100 peer-reviewed publications in print, over 35 technical notes and two books. He served on the 15-member team that authored and piloted the Malcolm Baldrige National Quality Award for Health Care, and he contributed to the Baldrige for Education.

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