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Monitoring Hospitals' Blood Wastage

February 2, 2011
by Jennifer Prestigiacomo
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America’s Blood Centers has implemented a new tool to monitor blood utilization, provide benchmarking data

To improve patient outcomes and offer savings to U.S. hospitals, the Washington, D.C.-based America’s Blood Centers (ABC), a North American network of non-profit community blood centers, has been rolling out a new tool, called Appropriate Inventory Management (AIM), to enable blood utilization tracking. The AIM software monitors availability of specific blood products, the inventory the hospital is carrying, unused or outdated units, and the appropriateness of a blood transfusion.

European Origins
ABC borrowed the idea for its AIM tool from an existing system, named VANESA, developed by the United Kingdom's National Health Service Blood and Transplant (NHSBT), which found a more than 10 percent drop in wastage after using it. ABC acquired the rights for the open source software and then added enhancements with the help of Surgical Outcomes Information Exchange (Richmond, Va.).

AIM module one, which monitors blood supply availability, operates on a data mining system that is provided via scripts that hospitals install in their clinical information systems. The software was rolled out a year ago at four organizations, BloodCenter of Wisconsin (Milwaukee), Mississippi Valley Regional Blood Center (Davenport, Iowa), Community Blood Center (Dayton), and Carter BloodCare (Dallas/Fort Worth), which then began pilots at their hospitals. After this initial implementation, some of the larger beta testers gave feedback about wanting automation for manual data entry. So, Kellie Kerr, director of ABC’s data administration, had that functionality implemented last August. Now, 18 blood centers and 360 hospitals use AIM to track their blood supplies.

“This all goes along with healthcare reform in attempts to reduce costs, while improving patient outcomes,” says Jim MacPherson, ABC’s CEO. “We’re trying to make sure that blood use is much more appropriate; patients, who don’t need transfusions, don’t get them, and the patients who need them, get them.”

Jim MacPherson

National Benchmarking, Infection Tracking
Last November, ABC rolled out AIM’s second module, which is based off a Finnish Web-based system that analyzes clinical outcomes and usage by provider. For those hospitals that have implemented module one, they can turn on module two at any time.

With module two, hospitals have access to 60 to 70 templates and can benchmark their blood utilization rates and progress against other hospitals. “We [gave] the hospital the ability to create their peer group every time they execute a report, so they choose who they want to benchmark themselves against, if they want to base it on hospitals that are same size, the same annualized transfusions, quantifications by blood products,” says Kerr. “So there’s a huge flexibility with the benchmarking.”

The system can also monitor for transfusion-associated infections and patient reactions through ICD-9 procedural and diagnostic codes. “All the codes during the admission of a patient have to be processed through government grouper software that assigns the MS-DRG,” says Kerr. “Because of it this is retrospective review. We’re working to make it more concurrent, but hospitals are happy with the retrospective [data] because it’s [gives] national benchmarking. ”

Future Cost Savings, Wastage Reductions
It is still too early to tell what savings and wastage reductions have been seen, as some hospitals are now just starting to install module one. MacPherson notes a dramatic decline in plasma wastage in a Dayton, Ohio hospital as an early sign of success. “We’re hoping to see what we saw in England, but it’s going to take time,” he says. “It took a year to two years for them to see an impact, so we’re a little early on.”

Kerr notes that cost savings will be tied to reductions in blood wastage and will be very hospital specific. “Given the fact that the total transfusions for hospitals cost between $20 to $25 billion a year, a 10 percent savings would be $2 billion—that would be huge, not nickels and dimes here,” adds MacPherson.

Next Steps
Kerr is excited about the many enhancements ABC has planned for the AIM system. Her team is in the process of expanding the benchmarking functionality in module two into the major diagnostic categories, as well as incorporating more procedural codes into benchmarking. ABC’s physician advisory committee is meeting with the Joint Commission, and both groups will be working on developing new blood measurement data sets, for which Kerr says AIM provides compliance with six of the seven sets so far.

MacPherson adds that ABC is working with the Centers for Disease Control and Prevention (Atlanta, Ga.) on its hemovigilance program that monitors transfusion-related patient reactions. “We will be able to collect data from the hospital and have that data sent directly to CDC’s database, so they can use that in their monitoring system,” he says.

Despite playing second fiddle to meaningful use priorities, Kerr is confident that she can sneak the AIM implementation into hospitals’ IT queues due to its modest time investment. According to Kerr, AIM requires no implementation, just a one-hour training with module one and a 30-hour implementation for module two.


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