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Blood Utilization at VUMC: Developing Systems Which Shape High Quality Care Gina Whitney, M.D. Departments of Anesthesiology and Pediatrics Slide 2 Beginnings Philosophical o Developing a model by which postoperative outcomes inform intraoperative practice Practical o Giving a large quantity of blood products intra-operatively o Empiric transfusion practice o Epidemic of capillary leak and prolonged ventilator dependence post-operatively Perioperative Blood Product Utilization in Pediatric Cardiac Surgery Slide 3 Slide 4 5 units 6+ units Slide 5 Koch, CG Ann Thorac Surg 2006; 81:1650-7. Slide 6 Two ventricle repairs without arch reconstruction April 1996 July 2004 270 patients Looked at intraoperative blood products 4-34 ml/kg LOW 35-67 ml/kg MEDIUM 68-364 ml/kg HIGH Measured DMV Slide 7 The Quality Case: PRBC transfusion is associated with dose- dependent increases in surgical site infection ventilator associated pneumonia duration of mechanical ventilation length of stay mortality Slide 8 Why (else) should we care about PRBC transfusion? FINANCIAL ALL BLOOD PRODUCTS >12, 700 TRANSFUSIONS in 2010 - VCH, ALL PRODUCTS ANNUAL FACTOR 7 UTILIZATION ~1 MILLION DOLLARS Slide 9 Blood Product Utilization Slide 10 Some problems are so complex that you have to be highly intelligent and well informed just to be undecided about them. -Laurence J. Peter Slide 11 Standardization of Intraoperative Practice Slide 12 Statistical Process Control Slide 13 Total PRBC per case - Anesthesia Slide 14 Red Cell Transfusion Implementation Period P=0.001 Slide 15 Total Cryo per Case - Anes Slide 16 Implementation Period Cryoprecipitate Transfusion P Balancing Measure Chest Tube Output Age < 180 days Age > 180 days Slide 21 Factor 7 Utilization Slide 22 Touchpoint: OR Exit Criteria ABG within 30 min of leaving room pH >7.3 Lactate