prof. dr. robert slappendel, anesthesiologist manager quality and safety, amphia hospital
DESCRIPTION
100% compliance of blood transfusion guidelines. Prof. dr. Robert Slappendel, anesthesiologist Manager Quality and Safety, Amphia Hospital Tias Nimbas Business School, Tilburg University. Conflicts of interest. All work is paid by Amphia Hospital - PowerPoint PPT PresentationTRANSCRIPT
Prof. dr. Robert Slappendel, anesthesiologistManager Quality and Safety, Amphia HospitalTias Nimbas Business School, Tilburg University
100% compliance of blood transfusion guidelines
Conflicts of interest
• All work is paid by Amphia Hospital • no payments by blood banks or
pharmaceutical industries.
Who wants to be a millionaire?
What’s the price of one unit of blood?
Answer:
1.€ 50,=
2.€ 200,=
3.€ 800,=
Price of blood (2009)
Costs of blood
Direct costs Indirect costs
Donor Blood bank
Collection Storage in hospital
Research Cross matching
Infections
Extra hospital stay
€200 € 800
After this session all hospitals using over 7800 units of blood can save
1 million euro a year
Topics to discuss
•Difference in transfusion rates•Risks of blood•The battle of the blood bank•Transfusion triggers•100% compliance to blood transfusion guidelines
•Results•Final conclusion
Variability of Transfusion Rates (2003)
1. van der Poel, C.L. and M.P. Janssen, Final Report - The collection, testing and use of blood and blood products in Europe in 2002 . 2005: Strasbourg.2. van der Poel, C.L. and M.P. Janssen, Final Report - The collection, testing and use of blood and blood products in Europe in 2003 . 2005: Strasbourg.
3. *Rouger P., Blood Transfusion in Europe: The White Book 2005, European Network of Transfusion Medicine SocietiesPublic Data from National Blood Authority, Australia
Denmark
Austria
Greece
Finland
Germany
Sweden
Belgium
Luxemburg
United Kingdom
Czechia
Hungary*
Slovenia Ita
ly
Netherlands
Malta*
Cyprus
Slovakia+
Ireland
Spain*
Portugal
France
Poland
Lithuania
EstoniaLatvia
Bulgaria
Romania
0.00
10.00
20.00
30.00
40.00
50.00
60.00
70.00
80.00
Donations per 1,000 populationRBC transfusions per 1,000 population
NL
Gombotz H, Rehak P, Shander A, Hofmann A. Blood use in elective surgery: the Austrian benchmark study. Transfusion 2007;47:1468-1480
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
15 12 13 16 9 3 1 7 2 11 4 6 5 8 14 10
Center No.
1,401 THR - patients transfused
Variability of Transfusion Rates for Matched Patients - Prospective Austrian Benchmark Study
Potential for Reduction
97.4% of all transfusions could have been predicted by:
1. Level of anemia prior to surgery2. Volume of perioperative blood loss3. Transfusion trigger
Blood loss per surgeon (THP)
surgeon A B C D
min 100 110 400 450
max 1150 1500 2100 2500
mean 400 410 800 1000
Take your surgeons apart!
Conclusion
•There are differences between
•countries•hospitals•doctors
Message:
•Get the data out of your own hospital and show it to your colleagues!
Topics to discuss
•Difference in transfusion rates•Risks of blood•The battle of the blood bank•Transfusion triggers•100% compliance to blood transfusion guidelines
•Results•Final conclusion
• Retrospective cohort study of all hospitalisations in the US in 2004 (n=38.66 million) to assess in-hospital outcomes associated with blood transfusion.
• 5.8% (2.33 million) transfused• After adjustment for age, gender, comorbidities,
admission type or DRG transfusion associated with:• 1.7 increased odds of death (P<0.0001)• 1.9 increased odds of infection (P<0.0001)• 2.5 days longer LOS• $17,194 higher charges (P<0.0001)
$40.1 billion more charges for txed pts!
Agreement Allogenic transfusions?
•Mortality•Morbidity
• Hospital stay• Infection rates• Wound disturbances
Topics to discuss
•Difference in transfusion rates•Risks of blood•The battle of the blood bank•Transfusion triggers•100% compliance to blood transfusion guidelines
•Results•Final conclusion
Source: America‘s Blood Centers, 2004
Blood Safety Measures – Another Cost Driver
Current topic: Age of transfused red blood cells
Reduced levels of 2,3 diphosphoglycerate Increased oxygen affinity Shape change Reduced deformability Decreased viability
Reduced tissue oxygenation
Acknowledgement: Gavin Murphy
Topics to discuss
•Difference in transfusion rates•Risks of blood•The battle of the blood bank•Transfusion triggers•100% compliance to blood transfusion guidelines
•Results•Final conclusion
New national guideline blood transfusions 2011
580 pages
270 medical specialist> 200 residents
100% compliance???Doctors???????
IHI Tool
100% compliance to guideline
IHI Tool
Ordering of blood
Normal ordering of blood(non acute bleeding patient)
Hemoglobin level
Orders the amount of packed cells!
Doctor thinks….
Amphia ordering(non bleeding patient)
Age Hemoglobin level Time after surgery (> of <4 hrs) Cardial or pulmonary problems
Determines the number of packed cells!
Physical barrier:If the doctor wants anything else than this guideline he has to motivate and call the lab
Topics to discuss
•Difference in transfusion rates•Risks of blood•The battle of the blood bank•Transfusion triggers•100% compliance to blood transfusion guidelines
•Results•Final conclusion
Basic Principle Dutch Guideline
• Hb-value is the main trigger for transfusion• No Hemoglobin value, no blood• < 4mmol/l all patients need to be transfused• < 5mmol/l might be better for patients > 60y• < 6mmol/l might be better for patients with a history of cardiac disease
Blood transfusionschecklist approaches 100% compliance
Year 2010 2011 2012 2013
Number of red cells 11453 11836 9928 9003
money €2.473.848 € 2.556.576 €2.144.448 €1.944.648
Difference € €412.128 €611.928
Inclusive Indirect
costs€1.6 million
Difference % 16.1% 23.9%
Blood supply in the Netherlands
0
100000
200000
300000
400000
500000
600000
700000
2000 2002 2004 2006 2008 2010 2012
29%
Number of transfusions /hospital admissions per 1000 inhabitants. (Netherlands)
0
20
40
60
80
100
120
140
2000 2006 2012
Number
year
transfusions
Hospital admissions
Benchmark Europa
010203040506070
Use of red blood cell units per 1,000 inhabitants (survey 2010)
Red Blood Cell Units per1,000 inhabitants
Survey 2010 European Directorate for the Quality of Medicines and Health Care
Nederland 2012Netherlands 2012
Topics to discuss
•Difference in transfusion rates•Risks of blood•The battle of the blood bank•Transfusion triggers•100% compliance to blood transfusion guidelines
•Results•Final conclusion
Blood supplyDonors
Costs
Risks
Side effects
5 drivers to change!
Efficiency, Quality and Patient Safety
Request for checklist: [email protected]