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CPOE Reducing I nappropriate Transfusions (CRIT) Collaborative.
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CPOE Reducing Inappropriate Transfusions (CRIT) Collaborative “The most cost effective opportunity to improve patient outcomes in the next quarter century will likely come, not from discovering new therapies but from discovering how to effectively deliver therapies that are known to be effective” Sean Berenholtz 2003
Old Way 5-15 years New Way 1-2 years
QI Collaborative Goals • Provide a venue for for multiple institutions to share experiences and projects surrounding blood utilization. • Utilize decision support tools to advance the adoption of evidence based practice in our institutions. • Set the framework for future collaborations using effective decision support tools.
Adult CDS Tool • Thanks to Irwin Gross, Eastern Maine Medical Center, and Bob Moser, Catholic Health East. 1) Is BP < 90 mm Hg (or 100 mmHg); if yes, rule does not fire 2) If BP is > 90 mm Hg, is the BP > 20 mm Hg LOWER than any SBP in the prior 6 hours; if yes, rule does not fire. 3) If BP > 90 AND is greater than the highest SBP in the last 6 hours minus 20 mm Hg, then rule fires alerting provider that transfusion does not meet guidelines
Oncology Patients • The problem- COG protocols have variable transgusions thresholds • Are these suggestions or potential protocol violations?? • The solutiuon- Insert language into CDS tool that exclude patients in COG protocols where transfusion thresholds are >7 gm/dl
Project Timeline 10/1/13 10/1/14 10/1/15 10/1/16 Year 1 Year 2 Year 3 Enroll CRIT affiliated institutions, IRB Install RBCT CDS tool and Validate Gather Baseline Data Build website and CRIT dashboard Early start cohort “go Live” 10/1/14 Late start cohort “go live” 4/1/15 Monitoring, Measurement, and Follow Up Conclusive Analysis and manuscript preparation
Baseline Data Data Inclusion criteria Age 1m- 18 yrs Admitted to the hospital greater than 24 hrs Total number of admissions Average pre-transfusion Hgb Transfusions Per patient day Defined as the most recent Hgb level drawn prior to transfusion Exclusion Criteria Less than 1 month More than 18 yrs Congenital heart disease Hgb SS, Thal. patients Transfusions in the OR ECMO All data should be broken down month to month starting January 2011
Next meeting Monday Monday August 26th 9:00 AM Spread the word!