Clinical Use of Blood The AIM II Trial Challenges of Near-Live Organisational Blood Use Monitoring
Goals for AIM Assist hospitals in complying with timely metric driven standards Create an inclusive approach to blood management To reduce costs of blood by tracking Key Performance Indicators (KPIs) Providing reports with national (and international) benchmarking to reveal evidence based best practice
How can we find out how blood is being used at the moment? Only by time consuming retrospective studies or prospective audit Or by asking transfusion teams for information
Blood Stocks Management Scheme Better information on stock management and wastage... Intelligence on blood inventory management gathered from across the blood supply chain Stock and wastage levels o Red cells o Platelets Benchmarking Transparency of data Significant improvements in inventory management
Appropriate Inventory Management (AIM) Overview Phase I (Module1) BSMS source code provided by NHSBT Collaboration between NHSBT/America s Blood Centres (ABC) American name: AIM I (Appropriate Inventory Management Module I) Phase II (Module 2) Goal: for vein to vein monitoring of blood component use (AIM II) Blood utilisation management requires patient level transfusion data in order to determine meaningful and appropriate use
Trial of AIM II in England: Trial in collaboration with 4 hospitals Present overview of system to hospital teams to enable evaluation of the resources required Evaluate the AIM II system functionality, assessing the fit for collection of blood use data Work with hospitals to establish data extraction & submission procedures Goal: a monthly data submission and reporting Benchmarking reports provided to hospitals
Participating Hospitals The Dudley Group of Hospitals NHS Foundation Trust The Newcastle upon Tyne NHS Foundation Trust University of South Manchester NHS Foundation Trust Oxford University Hospitals NHS Trust
Patient level transfusion data is needed to determine appropriate use: where are these data?
Data Elements for Blood Utilisation Analysis Transfusion yes or no? Patient ID (encrypted) Date of admission and discharge Year of birth Gender Healthcare Resource Group (HRG) Date and time of transfusion Transfused component Pre transfusion lab test result Donation number and product code Expiry date
Data elements for transfusion outcome evaluation Mortality Flag Ordering physician Directorate
Data related Data LIMS related data related to to blood to blood transfusion use episode results PAS data related to length of stay, consultant, specialty PAS coded data related to transfusion episode (ICD 10, OPCS4, HRG Codes) Hospitals extract relevant data (no patient identifiable features) Data warehouse hosted by ABC (in trial) Analysis and reports
Where are we... Significant hurdles Time and resource from Trust and laboratory IT specialists Matching of transfusion LIMS data to haematology LIMS data and PAS data on patient episodes One Trust is currently validating data prior to analysis
What is the hospital experience of AIM II? Transfusion Laboratory 10 hours required Significant time spent liaising with and advising pathology IT to enable gather of required data from LIMS Creation of translation table to convert product names into required code format
What is the hospital experience of AIM II? Pathology IT 15-20 hours required Several queries to obtain required information from LIMS Liaising with LIMS provider Conversion table for test parameters (to US standard)
What is the hospital experience of AIM II? Trust IT/ Information Systems 2-3 days to set up an extract that can be run regularly Formatting and linking the datasets Data sorting takes some time but once the procedures are established it should only take around 30 mins to provide Possible for this to include a degree of automation
Challenges Who s who? Data protection Current organisational workload/timescales o Electronic Patient Record Disparate data collection methods and systems (silos) Asking the wrong questions Infrastructure; what happens to the dataset when you have it? Maintaining Infrastructure and clinical buy-in No two organisations are the same
Red Cell Demand in England & N Wales
Comparison of use of red cells in 60 primary hip replacement Percentage of patients transfused 50 40 30 20 10 This hospital has: a pre op anaemia management pathway uses IV tranexamic acid to cover surgery has a strict post op transfusion trigger 0 Hospital 1 Hospital 2 Hospital 3 Hospital 4
Platelet Demand in England & N Wales
Which patients are receiving platelets in my hospital? (By HRG chapter) 60 50 40 30 20 10 0 Percentage transfused Nervous System Eyes and Periorbita Mouth Head Neck and Ears Respiratory System Cardiac Surgery and Primary Cardiac C... Digestive System Hepatobiliary and Pancreatic System Musculoskeletal System Skin, Breast and Burns Endocrine and Metabolic System Urinary Tract and Male Reproductive S... Female Reproductive System and Assist.. Obstetrics Diseases of Childhood and Neonates Vascular System Radiology and Nuclear Medicine Haematology, Chemotherapy, Radiothe... Undefined Groups Multiple Trauma, Emergency Medicine a.. Immunology, Infectious Diseases and ot... Critical Care and High Cost Drugs
Potential future integration: Recording the clinical reason for blood use The use of HRG is the reason for transfusion o This is less accurate for medical reasons for transfusion AIM II would be more easily targeted if there were a field in LIMS with a coded reason for clinical use The code should be from a standardised menu and would be selected by the person requesting the transfusion (ideally by electronic order comms)
Potential benefits of AIM II Better understanding of where and why blood is being used. Provide hospitals and physicians with benchmarking data. At individual hospital level, will be able to establish baseline performance and how it compares to regional, national or international peers Springboard for inter-hospital collaborations to identify best practice.
Potential benefits of AIM II NHSBT will benefit as knowledge of clinical use will inform strategic planning o Ensure sufficiency of supply through forecasts and trend monitoring o Maintain appropriate inventory levels to ensure supply meets demand o Information to evaluate safety decisions o Support emergency planning
Summary The goal of AIM II is to assist hospitals and physicians together with NHSBT to better manage and use the available blood supply Wide implementation would potentially offer local, regional, national and international benchmarking Challenges of data collection and clinical buy-in Further development will depend on the outcome of the current trial
Thank you Thanks to NHSBT