UK HealthCare (Lexington, Kentucky, U.S.A.) uses Allscripts EPSi™ to combine clinical and financial data for more complete and accurate decision support information. As detailed in a recent case study, this integrated data helped the organization measure outcomes from the modification of its transfusion program, which saved more than $2.4 million in direct costs over five years.
Why give two units when one will do?
When a patient has abnormally low hemoglobin (Hb) levels, it is common practice for clinicians to order Red Blood Cell (RBC) transfusions to help carry oxygen to all parts of the body. However, the threshold or “trigger” for when such transfusions are necessary has changed over the last several decades.
UK HealthCare used evidence-based guidance to evaluate its policy on RBC triggers and determined it could safely lower its transfusion trigger from 8 g/dL Hb to 7 g/dL Hb. The National Institutes of Health (NIH) suggested an Hb 7 trigger policy in 1988. Most institutions implemented an Hb 8 trigger policy as a compromise and UK HealthCare had done so as well. It also found that using one unit of RBCs could be as effective as the routine two-unit transfusion.
In 2010 UK HealthCare adopted this new policy and a transfusion committee developed an educational program for physicians, nurses and blood bank staff to explain the change and the rationale. Physicians practicing outside of the new trigger limits or ordering the previously routine two-unit RBC transfusion had to justify the medical necessity. All of the data is captured within EPSi, which receives the information automatically from the billing system.
“One of the clinicians involved with the RBC transfusions needed information down to the charge level and EPSi is the only system that combines the encounter with charge-level data,” Associate Director of Decision Support Todd Hjorth, MPA, said. “We could give them specific units billed, per day, per patient.”
As a result of UK HealthCare’s efforts to modify its blood transfusion protocols, it saved 11,575 RBC units and avoided unnecessary transfusions over five years, when compared to a 2009 baseline. “EPSi helped us show the direct cost savings over five years was more than $2.4 million,” Hjorth said. “If we use activity-based costing, the savings would have more than doubled that amount.”