IHI Expedition. Today s Host 9/17/2014

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1 September 6, 204 Begins at 3:00 PM EST These presenters have nothing to disclose IHI Expedition Expedition: Appropriate Use of Blood Products Session 3: Transfusion Safety Program Infrastructure: Measures of Clinical Effectiveness Timothy Hannon, MD, MBA Diane Jacobson, MPH, CPHQ Today s Host 2 Morgen Palfrey, Project Coordinator, Institute for Healthcare Improvement, is the current coordinator for web- based Expeditions. She also contributes to the IHI Leadership Alliance, the Always Project, and works with Strategic Partners in Singapore. Morgen is a member of Work- Life Wellness Team and Diversity and Inclusion Council at IHI, where she and fellow staff members develop strategies for improving the mind and body. Morgen graduated from the University of Florida in Gainesville, FL where she received her Bachelor of Arts degree in Political Science with a concentration in Public Administration.

2 Audio Broadcast 3 You will see a box in the top left hand corner labeled Audio broadcast. If you are able to listen to the program using the speakers on your computer, you have connected successfully. Phone Connection (Preferred) 4 To join by phone: ) Click the button on the right hand side of the screen. 2) A pop-up box will appear with call in information. 3) Please dial the phone number, the event number and your attendee ID to connect correctly. 2

3 Audio Broadcast vs. Phone Connection If you using the audio broadcast (through your computer) you will not be able to speak during the WebEx to ask question. All questions will need to come through the chat. 5 If you are using the phone connection (through your telephone) you will be able to raise your hand, be unmuted, and ask questions during the session. Phone connection is preferred if you have access to a phone. WebEx Quick Reference Welcome to today s session! Please use chat to All Participants for questions For technology issues only, please chat to Host WebEx Technical Support: Dial-in Info: Communicate / Join Teleconference (in menu) Raise your hand Select Chat recipient Enter Text 6 3

4 When Chatting 7 Please send your message to All Participants Expedition Director Diane Jacobsen, MPH, CPHQ, Director, Institute for Healthcare Improvement (IHI) is currently directing the CDC/IHI Antibiotic Stewardship Initiative, NSLIJ/IHI Reducing Sepsis Mortality Collaborative. Ms. Jacobsen served as IHI content lead and improvement advisor for the California Healthcare-Associated Infection Prevention Initiative (CHAIPI) and directed Expeditions on Antibiotic Stewardship, Preventing CA-UTIs, Reducing C.difficle Infections, Sepsis, Stroke Care and Patient Flow. She served as faculty for IHI s 00,000 Lives and 5 Million Lives Campaign and directed improvement collaboratives on Sepsis Mortality, Patient Flow, Surgical Complications, Reducing Hospital Mortality Rates (HSMR) and co-directed IHI s Spread Initiative. She is an epidemiologist with experience in quality improvement, risk management, and infection control in specialty, academic, and community hospitals. A graduate of the University of Wisconsin, she earned her master s degree in Public Health- Epidemiology. 8 4

5 Today s Agenda 9 Ground Rules & Introductions Debrief: Session 2 Assignment Transfusion Safety Program Infrastructure: Measures of Clinical Effectiveness Action Period Assignment Expedition Objectives 0 At the end of this Expedition, participants will be able to: List the quality, economic, and risk management issues driving the need for safer blood use. Discuss the pathway required for successful implementation of evidence-based transfusion guidelines. Develop three to five key performance indicators for effective Transfusion Safety Committee oversight Identify the essential elements of a sustainable Transfusion Safety Program. Describe issues of transfusion safety at the bedside and strategies to improve transfusion administration safety. 5

6 Schedule of Calls Session Update on Transfusion Safety Date: Tuesday, August 9, 3:00-4:30 PM ET Session 2 Transfusion Safety Program Infrastructure: Implementing Transfusion Guidelines Date: Tuesday, September 2, 3:00-4:00 PM ET Session 3 Transfusion Safety Program Infrastructure: Measures of Clinical Effectiveness Date: Tuesday, September 6, 3:00-4:00 PM ET Session 4 Transfusion Safety Program Infrastructure: Critical Role of Leadership Date: Tuesday, September 30, 3:00-4:00 PM ET Session 5 Nursing at the Bedside: Transfusion Administration Safety Date: Tuesday, October 4, 3:00-4:00 PM ET Session 6 Best Practices: Communication and Awareness Strategies Date: Tuesday, October 28, 3:00-4:00 PM ET Session 7 Putting it All Together: Building a Sustainable Program Date: Tuesday, November, 3:00-4:00 PM ET Action Period Assignment Debrief Read Transfusion Guidelines: Development and Impact on Patient Blood Management book chapter Locate and review your hospital s current transfusion guidelines Determine what systems you currently have in place for blood utilization review - Explore gaps, opportunities for enhancing the process - Identify one specific change to test to improve the process Identify key stakeholders to add to your current blood utilization/ transfusion safety committee 2 What did you test and learn? 6

7 Faculty Timothy Hannon, MD, MBA, is a board certified anesthesiologist with over 20 years experience leading large-scale healthcare change initiatives to improve the safety, quality and efficiency of patient care across the nation. As the visionary founder and CEO of Strategic Healthcare Group, a consulting and informatics company focusing on Blood Management and Transfusion Safety, Dr. Hannon partnered with major healthcare systems to rapidly and sustainably improve transfusion practices, resulting in almost 400,000 blood products saved and total healthcare cost savings approaching $600,000,000. More importantly, by reducing unnecessary transfusions through evidencebased practices and bleeding edge clinical pathways, Dr. Hannon and his team were able to help hospitals avoid 2,700 complications, reduce 476,000 inpatient days, repurpose 700,000 nursing hours, and save 2900 lives. 3 Transfusion Safety Program Infrastructure: Measures of Clinical Effectiveness Tim Hannon, MD, MBA September,

8 Disclosures None 5 Introduction Agenda General approach to developing performance measures Improving clinical acceptance and accountability for compliance with performance measures Examples of transfusion safety performance measures 6 8

9 Transfusion Safety Committee Tools The effective Transfusion Safety Committee uses a variety of tools to achieve and maintain improvements, including: Ongoing provider education Process improvement tools Change management strategies Transfusion practice analytics Each of the tools in the toolkit are necessary but not sufficient 7 Should Blood Transfusion be a Quality Indicator? It may be time for patient blood management to gain status as a performance indicator by accreditation agencies such as the Joint Commission or as a quality indicator by professional organizations such as the STS as part of transparency and public rankings for consumers. Shander, Goodnough, JAMA 200;304(4) 8 9

10 General Approach to Developing Performance Measures 9 Performance Measures for Naval Aviation Relevance Measurability Comparability 20 0

11 General Approach to Performance Measures Effective performance indicators have at least 3 characteristics: Relevance Measurability Comparability Start with a small set of measures that are impactful and easily obtainable, then build upon them Make sure to include all stakeholders in the process of development, implementation and monitoring The benefits of performance measure development are significant for the organization as a whole: The process of developing performance measures by it s nature will stimulate learning and knowledge exchange (internal and external) Participating in performance measures is a powerful message that the organization is invested in quality improvement Don t forget the Hawthorne Effect! de Korne, HealthCareMgmtRev 200:35() 2 Improving Acceptance and Accountability for Performance Measures 22

12 Pre-empting Objections to Performance Measures Relevance: Blood can t hurt, might just help Broad education about evidence-based transfusion practice and the dramatic shift in transfusion risks and benefits Top down communication strategies relating blood utilization improvement efforts as a patient safety initiative Measurability: This is bad data! Specify upfront sources of data and any limitations, such as attribution issues Emphasize that data will not be used in isolation, and that trends are more important than isolated data points Comparability: My patients are older/ sicker! Use reasonable measures to group similar patients with adjustments for comorbidities Reemphasize that this is about patient safety! 23 Improving Clinical Acceptance of Performance Measures Clinicians are more likely to change their transfusion practices if they: Are shown trend data rather than isolated points Are shown how their transfusion practice compares to their peers (internal benchmarks) Are shown how their transfusion practice compares to best practice in their field of expertise (external benchmarks) Are shown outcomes data in relationship to their transfusion rates (e.g., LOS, infection rates, wound complications) Wilson et al. Transfusion 2002;42(9) 24 2

13 Promoting Accountability for Performance Measures Use mechanisms to hold clinicians accountable that have been successful in the past for quality and safety initiatives within the organization Compliance with evidence based transfusion guidelines and transfusion safety best practices should have the full backing of clinical leadership (including the CMO) and the Medical Executive Committee Education and feedback should accompany presentation of data Whenever possible and/ or appropriate, present unblinded data Peer-to-peer comparisons are particularly powerful In spite of any objections, physicians do not like to be viewed as outliers 25 Transfusion Safety Performance Measures 26 3

14 Transfusion Safety Error Rates :3,000- :2,000,00-2% %? 30-70% :4, % Recruit Donor screening Collect & prepare Infectious disease tests Blood Safety Pre-transfusion testing Medical decision to transfuse Issue/ transport Bedside ID/ administration Monitor & evaluate Transfusion Safety Dzik, Transfusion 2003;43 2 Maskens, Transfusion 204;54() 27 Examples of Transfusion Safety Performance Measures 28 4

15 Transfusion Service Efficiency CT Ratio Blood product wastage rates By product type By cause Specimen rejection rates Specimen rejection rates are a major source of inefficiency, a source of conflict between lab and nursing staff, and a potential patient safety issue (WBIT) 29 Global Blood Utilization Measures 30 5

16 Volume Adjusted Blood Utilization Rate- Hospital Average Pre-transfusion Laboratory Value 6

17 Percent Single Unit Transfusions (PRBC) Department and Physician Specific Measures 34 7

18 Percentage Transfusion Rate- Department Hemoglobin Triggers and Targets Frank et al. Transfusion 203;53 (2) 8

19 Hemoglobin Triggers and Targets Frank et al. Transfusion 203;53 (2) Automating Measures of Transfusion Appropriateness Cohn et al, Transfusion 204;54(2) 38 9

20 Transfusion Administration Safety Performance Measures Under recognition and underreporting of transfusion related adverse events is common and a major patient safety issue,2 Transfusion reaction rates should be viewed as an indicator of vigilance, competency and inter-department communication for nursing at the bedside Compliance with dual identification and vital sign documentation should also be monitored Thomas, Baffa, Hannon. Oral abstract, SABM meeting Oct Thomas, Baffa, Hannon. Transfusion 202:52(S3);235A 39 Benchmarks for Blood Utilization 40 20

21 Internal vs. External Benchmarking Advantages of internal benchmarking Can generally be done quickly at fairly low cost Provides a baseline state for process improvement Can be very useful for peer-to-peer comparison Disadvantages of internal benchmarking No external reference point(!) Missed opportunities to learn from other organizations who are performing at a higher level 4 Blood Utilization Benchmarking Resources Taylor, Yomtovian, Transfusion 203;53(3) 42 2

22 Summary Implementing performance measures for transfusion safety has multiple benefits at the physician, department and organizational level Education on evidence-based transfusion practice and framing the effort as a patient safety initiative are necessary components of changing clinical practice Key stakeholder groups should be involved in all stages of development, implementation and monitoring of performance measures Start with a small set of impactful measures that are readily obtainable and build on them The goal is to develop a broad set of transfusion safety performance measures that help to analyze, improve and control the process of safe transfusion practices from donor to patient 43 Transfusion Safety Program Infrastructure: Measures of Clinical Effectiveness Tim Hannon, MD, MBA THannonMD@gmail.com 44 22

23 Questions? 45 Raise your hand Use the Chat Action Period Assignment 46 Determine the reporting structure of your current Blood Management program for the assigned personnel and for program results If you don t currently have an established Blood Management Program, identify the key components you would identify for the reporting structure in your organization. Reach out to your nursing leadership team, asking them to describe the role of nursing in safe transfusion practices Come prepared to share what you learned, including any insights/surprises 23

24 Expedition Communications 47 Listserv for session communications: To add colleagues, us at Pose questions, share resources, discuss barriers or successes Next Session 48 Session 4: Transfusion Safety Program Infrastructure: Critical Role of Leadership Tuesday, September 30 th, 3:00 PM 4:00 PM ET 24