Through a review of blood utilization in the surgical units, the administrative manager of clinical operations for a large hospital noted what she believed to be a significant variation in the number of transfusion orders being placed per surgical case among the surgeons on staff. She brought the question to the surgical quality improvement committee, and the committee initiated a review of current standard practice for ordering transfusions within the surgical units of the hospital and also a review of best practices as supported by current research evidence. They discovered that the evidence from transfusion research revealed that transfusion therapy can result in a variety of adverse patient outcomes, including the transmission of infection diseases and allergic reactions. As a result, the hospital medical staff moved to adopt as its general “best practice” for transfusion ordering: a minimum hemoglobin concentration of 7g/dL (21% hematocrit) as an indication for red cell transfusions and a 10g/dL hemoglobin concentration (30% hematocrit) as a level at which transfusion therapy usually is unnecessary.
After the approved “best practice” guideline was introduced to the medical staff, a blood utilization dashboard was developed that helps responsible clinical managers identify at the physician level when transfusion orders are placed contrary to the guideline. Having this information available enables the clinical manager to address the issue on a unit or with the individual physician involved. Use of this dashboard has resulted in significant reduction in the variation in transfusion ordering practices among the medical staff and a significant reduction in blood utilization, which equates to a significant reduction in costs of maintaining the blood supply, and an improvement in patient outcomes.
1. What data elements must be accessed from the clinical data repository to drive the blood utilization dashboard?