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

Collaborative Goals

• Provide a venue for for multiple institutions to share experiences and projects surrounding blood utilization.

• Test the hypothesis that CPOE tethered to CDS can improve and hasten the adoption of evidence based guidelines across multiple institutions.

• Set the framework for future collaborations using effective decision support tools.

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

Brian Hoberman Kaiser Northern California

Melissa Frei-Jones UTHSC Santa Rosa Children’s Hospital

Meeting Agenda

• Introductions.• Group Email.

• Discuss institutional progress on the CRIT project, and gathering baseline data.

Evidence based algorithm

Adams Pediatrics 2011

Decision Support Window

Adams Pediatrics 2011

Total transfusions per patient day decreased from 0.075 to 0.05.

Adams Pediatrics 2011

The average pre-transfusion Hgb decreased in both the PICU and acute care

wards

Pre-interve

ntion

Post-interve

ntion1357

Pre-intervention Post intervention02468

1012

9.88.7

7.55 7.14

Adams Pediatrics 2011

CDS Decreases Blood Transfusions on the Acute Care Wards

Adams Pediatrics 2011

CDS Decreases Blood transfusions in the PICU

Adams Pediatrics 2011

The Clinical Effect of CDS Is Sustainable20

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Adams- Unpublished

Data Collection 1 year

Proposed CRIT QI study design

Initiation Middle Late

Initiation Middle Late

Early Cohort

Late Cohort

Baseline Data

Inclusion criteria

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

Exclusion Criteria

Less than 1 monthMore than 18 yrsCongenital heart diseaseHematology patients

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

Baseline Data

Total number of transfusions for patients that meet the inclusion criteria

Hgb levels just prior to the transfusion

Total number of patient days for patients that meet the inclusion criteria

ExampleDischarge Year-Month Blood Orders Patient Days RPPD

2008-02 81 288 0.28

2008-03 230 494 0.47

2008-04 67 194 0.34

2008-05 35 259 0.14

2008-06 81 412 0.20

2008-07 37 300 0.12

2008-08 100 555 0.18

2008-09 30 321 0.09

2008-10 70 319 0.22

2008-11 25 326 0.08

2008-12 81 470 0.17

2009-01 52 326 0.16

2009-02 44 281 0.16

2009-03 48 263 0.18

2009-04 42 212 0.20

2009-05 77 398 0.19

2009-06 80 486 0.16

2009-07 86 447 0.19

2009-08 26 324 0.08

2009-09 16 215 0.07

2009-10 43 329 0.13

2009-11 97 487 0.20

2009-12 64 546 0.12

2010-01 35 411 0.09

Institution CommitteeApproval

IT Baseline Data

IRB CDS Live RandomizedAnalysis

Children’s Hospital Orange County

X X

Children’s Hospital of Michigan

Children’s Hospital Boston X XUniversity of Illinois at Chicago XAll Children’s Hospital, Florida

Mercy Children’s Hospital X XChildren’s Hospital Minnesota

Nationwide Children’s Hospital

MetroHealth, Case Western X

Chldren’s Hospital of Richmond X X

Rady Children’s Hospital

Helen DeVos Children’s Hospital

Akron Children’s Hospital

Eastern Maine Medical Center X

Shriners Hospitals UTHSC Santa Rosa Children’s Hospital

X

Next meeting

Monday Tuesday May 29th 9:00 AM

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