The Oracle Health and Cerner Value Management Advisory Services team helped support care planning to decrease blood loss and enhance an individual’s own blood supply collection.
“We’ve been able to identify certain cases we couldn’t identify before and review with our patient blood management advisory committee.”
In 2007, Northern Light Health began the state’s first comprehensive blood management program to help provide patients with safe and high-quality care. The Brewer, Maine-based health system is recognized by national organizations including the Society for the Advancement of Blood Management, and accommodates over 129,000 ED visits and 34,500 surgeries with its nearly 1,000 beds. Recently, the organization started offering tele-anemia services at one of the remote hospitals within its system. The program will likely be expanded to other member hospitals in the future.
Blood management is about providing safe, high-quality care for patients with low hemoglobin (commonly called anemia)—a condition where there are low levels of red blood cells that carry oxygen to body tissues.
However, giving blood when it is not necessary exposes the patient to significant risks. Inappropriate and avoidable transfusions may increase mortality, length-of-stay, and nosocomial infections. Northern Light Health. Hoped to close gaps in data collection. Without adequate data, the organization had a difficult time finding the outliers—providers who inappropriately transfuse blood beyond the best evidence-based practices.
The Northern Light Laboratory Transfusion Service works hand in hand with the Patient Blood Management program at Northern Light Eastern Maine Medical Center.
“My predecessor started the patient blood management program, established a data collection system for blood management, and was the medical director of the blood bank,” says Kael Mikesell, DO, medical director, Northern Light Patient Blood Management. “Northern Light Eastern Maine Medical Center became known as an industry leader for one of the most advanced patient blood management programs in the country.”
Northern Light Patient Blood Management uses a team approach to develop a plan of care that uses the latest drugs, technologies, and techniques to decrease blood loss and enhance an individual’s own blood supply.
The Oracle Health and Cerner Value Management Advisory Services team started working with the team at Northern Light Patient Blood Management in September 2019 to help improve blood management data collection.
“It helped to have someone who could identify holes in our data collection,” says Mikesell. “The Cerner team worked diligently with us to accomplish this.”
“We manually track patients we’re involved with, whether we are reviewing it on our own or we’re requested to review it,” says Mikesell. “The problem was, we felt like we were missing part of what we needed to know, and the data we got from the system didn't provide enough detail.”
Collating and managing the data from various sources is a cumbersome process of pulling all of it together and arranging the data chronologically. Having only the high-level summary data and not the detailed patient-level data caused a lot of searching for missing information.
“I could maybe drill down to the department level, but not any further,” says Mikesell.
This is where the Value Management Advisory Services team showed its expertise. It developed data tools to drill down and find what Northern Light Health needed. After the initial data validation, in March 2020 the Value Management Advisory Services team worked with the Information Systems at Northern Light Health to recreate the visuals into a Tableau dashboard, which provided more detailed insight into blood utilization, for example, by facility, specialty, and even nursing unit.
“We’ve been able to identify certain cases we couldn’t identify before and review with our patient blood management advisory committee,” says Mikesell. “I can now look down to the provider level and see exactly what they are doing. We've been lacking solid data that can get down to the individual patient and individual provider level.” For example, a provider may decide to transfuse two units of blood when only one was required; or maybe no blood was required at all.
As leaders prepared for the possibility of a COVID-19 patient surge in spring 2020, the organization's blood management program continued to support its strategic operational plan by managing expenses. While Maine wasn’t as heavily impacted by COVID-19 as other parts of the US, Northern Light Health had an operational plan to expand intensive care and use its blood management program in case a big wave hit.
“We saw a decrease in pre-op work because many surgeries were canceled. Our anemia clinic wasn't busy, but the inpatient blood management program was as busy as ever. To reduce blood usage in response to COVID-19, we started reviewing all hospital cases with a hemoglobin less than eight grams/deciliter.”
Since Oracle Health’s involvement, the percent of blood given above a hemoglobin level of 8.0 has reduced from a monthly average of 11% to an average of 8.5%.
Moving forward, Northern Light will look at other hospitals within its system that have a pre-transfusion hemoglobin that's higher than their peers. Although the overall number of blood units they give is lower, every transfusion should be considered as potentially harmful for the patient and given only when the tangible benefits outweigh the risks.
“There are still more opportunities to tackle, and the dashboards help bring those to light,” says Mikesell. “It's one thing to say, ‘We need to do better with transfusions.’ It's a whole other story when you can say: ‘Here's the data, you're not meeting the current best practices.’ We couldn't do that effectively before.”
1 A 22% percentage change, comparing January 2019 to December 2019 against January 2020 to July 2020.