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

Introduction of Collaborative Participants

CONTACT INSTITUTION

Richard Chang, Geetha PuthenveetilChildren’s Hospital Orange County

Suresh Srinivasan Children’s Hospital of Michigan

Marvin Harper, Jenifer Lightdale Children’s Hospital Boston

Eloa Adams, Chris Longhurst Lucile Packard Children’s Hospital

Munirah Curtis, Sara Boblick Smith University of Illinois at Chicago

Calvin Popovich All Children’s Hospital, Florida

Phil Spinella Washington University, St Louis

Rod Tarrago, Judy Zeir Children’s Hospital Minnesota

David Rich Nationwide Children’s Hospital

David Kaelber Metrohealth, Case Western

Marissa Tucci CHU Sainte-Justine Research Center

Introduction of Collaborative Participants

CONTACT INSTITUTION

Colin Banas , Sean McKenna Children’s Hospital of RIchmond

Lejla Music-Aplenc Mercy Children’s Hospital

Nabil Hassan Helen DeVos Children’s Hospital

Cynthia Kaelbs Rady Children’s Hospital

Amy Maneker Akron Children’s Hospital

Adam Campbell Shriners Hospitals

Irwin Gross Eastern Maine Medical Center

Robert Moser Catholic Health East

Meghan Delaney Seattle Children’s

Melissa Frei-Jones UTHSC Santa Rosa Children’s Hospital

Jim Fackler Johns Hopkins

Meeting Agenda

Old Way

New Way5-15 years

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

Patient Centered Outcomes Research Institute Timeline

Year 1 Year 2 Year 3

10/1/13 10/1/14 10/1/15 10/1/16

Enroll CRIT affiliated

institutions, IRB

Install RBCT CDS tool and Validate

Gather Baseline Data

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

Project Timeline

Build website and CRIT dashboard

Baseline Data

Inclusion criteria

Age 1m- 18 yrsAdmitted to the hospitalgreater than 24 hrs

Exclusion Criteria

Less than 1 monthMore than 18 yrsCongenital heart diseaseHgb SS, Thal. patientsTransfusions in the ORECMO

Data

Total number of admissionsAverage pre-transfusion HgbTransfusions Per patient day

Defined as the most recent Hgblevel drawn prior to transfusion

All data should be broken down month to month starting January 2011

Institution CommitteeApproval

IT Baseline Data

IRB CDS Live RandomizedAnalysis

Children’s Hospital Orange County X X X X

Children’s Hospital of Michigan

Children’s Hospital Boston X X

University of Illinois at Chicago X X

All Children’s Hospital, Florida

Mercy Children’s Hospital X X

Children’s Hospital Minnesota X X X X X

Nationwide Children’s Hospital

MetroHealth, Case Western X

Chldren’s Hospital of Richmond X X

Johns Hopkins

Children’s National Medical Center

Akron Children’s Hospital

Eastern Maine Medical Center X X

Shriners Hospitals

University of Washington in St. Louis X X X

Seattle Childrens Hospital X X X

Next meeting

Monday Monday August 26th 9:00 AM

Spread the word!