Northern Light Health — a Brewer, Maine-based health system with nearly 1,000 beds, 129,000 ED visits and 34,500 surgeries — began the state’s first comprehensive blood management program in 2007 to help provide patients with safe and high-quality care. Recognized by national organizations including the Society for the Advancement of Blood Management, leaders hoped to close gaps in data collection. Typical to the progressive leadership they have demonstrated, they recently started offering tele-anemia services at one of the remote hospitals within their system, and 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 (i.e. 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. Without adequate data, Northern Light Health 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,” said 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 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,” said 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,” said 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 digging around for missing information.
“I could maybe drill down to the department level, but not any further.”
This is where the Value Management Advisory Services team showed their expertise and capabilities; 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 provides 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,” said 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 their strategic operational plan by managing expenses. While Maine hasn’t been as heavily impacted by COVID-19 as other parts of the US, Northern Light Health has an operational plan to expand intensive care and utilize its blood management program if a big wave hits.
“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 Cerner’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%.1
Moving forward, Northern Light will look at its other hospitals within their 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 only given when the tangible benefits outweigh the risks.
“There are still more opportunities to tackle, and the dashboards help bring those to light,” said 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–December 2019 to January–July 2020