Blood Utilization Review System
Many laboratory directors and healthcare institutions offering transfusion services wish they had a simple, automated way to review conditions under which units of blood products are requested and/or transfused. Specifically, they want to know the values of certain lab test results both prior to the transfusion and also for some period of time following the transfusion. However, the monitored lab procedures and/or their threshold values are usually different for each blood product category. Further, there is often the need to monitor these results and transfusions by some additional category, such as facility or medical service.
For example, a red blood cell transfusion may require the monitoring of hemoglobin and hematocrit values prior to and after the transfusion, but a platelet transfusion may require monitoring platelet count only, or platelet count and bleeding time. One facility or medical service may desire to monitor test values for the 24-hours pre-transfusion and post-transfusion while another may have a different time requirement. Or, one medical service may have test threshold values different than those required by another service (e.g., oncology may have a pre-RBC transfusion hemoglobin threshold of 6 gm/dl instead of the usual 8 gm/dl).
Historically, the process of monitoring and reviewing blood product utilization has been clumsy, time-consuming and often limited to what non-result criteria could be brought into the analysis. Even in this age of computerized laboratory systems and electronic data, few systems offer any degree of flexibility in specifying which test results or criteria to monitor for which blood products.
The Blood Utilization Review System available from Paladin Consulting Group simplifies the task of specifying the critical data to be considered for each transfusion type, retrieving that data for each transfusion event and presenting the data in an easily reviewable format. By providing user-maintained databases for blood product categories, lab procedures, thresholds, intervals and a second category (typically medical service or facility), the system allows the institution to tailor the system to its specific needs and to maintain and modify the system without outside assistance as situations may change. Each blood product category may be set up to monitor up to three (3) lab procedures with individual monitoring intervals for each blood product category. Further each of the additional category entries (facilities, medical services, etc.) can have their own individual procedures for monitoring and their own specific intervals. The number of blood product categories is unlimited, as are the number of elements in the additional data category (which can represent any data element in the Cerner database). Moreover, all of the lab procedures to be monitored for a blood product category, their threshold values, and their time intervals pre-transfusion and post-transfusion can be different for each additional data category.
For example, consider a multi-facility medical center where the same procedure has a different name at each facility. In addition, Facility 1 wants to use a 48-hour interval for monitoring while Facility 2 prefers a 24-hour interval. Further, Facility 1 wants to use different threshold values for monitoring than does Facility 2. All of this is easily configured in the Paladin Blood Utilization Review System. For institutions that don’t have multiple facilities or that prefer to monitor by medical service, the same scenario above is possible (substituting medical service for facility).
Not only does the Paladin Blood Utilization Review System capture the transfusion events where lab results are out of an acceptable range (either too high or too low), it also captures transfusion events where lab procedures are not performed within the specified pre-transfusion and post-transfusion intervals, as well as those transfusion events where the monitored lab procedures are not performed at all.
The Blood Product Utilization Review System is fully customizable through a simple and intuitive user interface. All data is stored on Cerner-compatible Tables. Installation, testing and customization services are offered, as well as a PC-based Access database of longitudinal blood product utilization data, complete with FTP transfer and automated import utilities.
Reporting can be done through Operations as a fully automatic process or can be run "on-demand" through user intervention. The report can span whatever time-frame is supported by the Cerner Patient Orders Database purge criteria as established by each institution. The report provides sorting and sub-totaling by physician within the sort for the additional category (medical service, facility, etc.). Reports can be generated for all blood product categories or only for specified ones and for all members of the additional category (medical service, facility, etc.) or only for selected ones.
Click here to see a sample report.
