Using Multi-Disciplinary Education to Promote Blood Conservation During Cardiac Surgery Tamara S. Goda DNP, ANP-BC, Joseph Elbeery, MD, Alan Kypson, MD, Richard D’Alonzo, MD, PhD, Derek Sanderson, CCP, Linda Kindell, BSN, RN, April Quidley, PharmD Cardiac Surgery Clinicians n=29 Pre Post p value Reporting practice reflective of CPG 44.8% 75.9% p= 0.012 Reporting use of FFP empirically for bleeding 44.8% 24.1% p=0.894 Reporting knowledge and application of TEG for transfusion decision making 51.7% 86.2% p=0.007 Intervention Interdisciplinary education highlighting the recommendations of the 2011 STS Clinical Practice Guidelines for Blood Conservation in Cardiac Surgery. Transfusion triggers and protocols for the use of thromboelastography (TEG) to guide pre and post-op transfusion decision making. • Cardiac surgeons • Anesthesiologists • Perfusionists • CRNAs • NPs and PAs Transfusion practice can vary extensively for patients undergoing cardiac surgical procedures. This variability has led to high utilization of blood products despite the evidence that administration of allogenic transfusions negatively impact patient outcomes and long term survival. A review of the literature confirmed that transfusion practice variability was largely associated with failure to recognize the importance of the healthcare team. Project outcomes included: a) Improvement in clinician knowledge related to the STS Blood Conservation CPGs; and b) Decreased blood product utilization for patients undergoing cardiac surgical procedures. Participants’ scores reflected an improvement in the overall knowledge of the STS CPGs noting a 31.1% (p=0.012) increase in the number of participants whose practice reflected the Blood Conservation CPGs post intervention. Additionally, there was a reduction in utilization of packed red blood cells (PRBCs) of 8.4% for coronary artery bypass (CAB) and 15.2% for CAB/valve replacement procedures noted post intervention. Abstract References Ferraris, et al., (2011). 2011 Update to the society of thoracic surgeons and the society of cardiovascular anesthesiologists blood conservation clinical practice guidelines. Annals of Thoracic Surgery, 91(3), 944-982. Maddox, et al., (2009). Institutional variability of intra-operative red blood cell utilization in coronary artery bypass graft surgery. American Journal of Medical Quality, 24(5), 403-411. Snyder-Ramos, et al., (2008). The ongoing variability in blood transfusion practices in cardiac surgery. Transfusion, 48, 1284-1299. Vidant Medical Center • Greenville, NC Outcomes 0 100 200 300 400 500 600 700 Q1 2013 N=243 Q2 2013 N=239 TEG Started Q3 2013 N=227 Q4 2013 N=272 Q1 2014 N=209 Q1 2014 N=189 Total Blood Product Transfusion Volumes for all Procedures Q1 2013 Q4 2014 CRYO FFP PLT RBC 53% 46% 90% 83% 0% 20% 40% 60% 80% 100% Pre (2011 - Q2 2013) Post (Q3 2013 - Q2 2014) PRBC Use Pre and Post CAB AVR+CAB,MVReplace+CAB,MVRepair+CAB Institutional data from 2011 & 2012 reveals blood utilization for coronary artery bypass (CAB) & CAB/valve replacement procedures 6-11.6% higher than like academic medical centers and the Society of Thoracic Surgery (STS) benchmark.

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Page 1: Using Multi-Disciplinary Education to Promote Blood ...dnpconferenceaudio.s3.amazonaws.com/2014/1Poster... · Using Multi-Disciplinary Education to Promote Blood Conservation During

Using Multi-Disciplinary Education to Promote Blood Conservation During Cardiac Surgery

Tamara S. Goda DNP, ANP-BC, Joseph Elbeery, MD, Alan Kypson, MD, Richard D’Alonzo, MD, PhD, Derek Sanderson, CCP, Linda Kindell, BSN, RN, April Quidley, PharmD

Cardiac Surgery Clinicians n=29

Pre Post p value

Reporting practice reflective of CPG

44.8% 75.9% p= 0.012

Reporting use of FFP empirically for bleeding

44.8% 24.1% p=0.894

Reporting knowledge and application of TEG for transfusion decision making

51.7% 86.2% p=0.007

Intervention

Interdisciplinary education highlighting the recommendations of the 2011 STS Clinical Practice Guidelines for Blood Conservation in Cardiac Surgery.

Transfusion triggers and protocols for the use of thromboelastography (TEG) to guide pre and post-op transfusion decision making.

•  Cardiac surgeons •  Anesthesiologists •  Perfusionists •  CRNAs •  NPs and PAs

Transfusion practice can vary extensively for patients undergoing cardiac surgical procedures. This variability has led to high utilization of blood products despite the evidence that administration of allogenic transfusions negatively impact patient outcomes and long term survival.

A review of the literature confirmed that transfusion practice variability was largely associated with failure to recognize the importance of the healthcare team.

Project outcomes included: a) Improvement in clinician knowledge related to the STS Blood Conservation CPGs; and b) Decreased blood product utilization for patients undergoing cardiac surgical procedures.

Participants’ scores reflected an improvement in the overall knowledge of the STS CPGs noting a 31.1% (p=0.012) increase in the number of participants whose practice reflected the Blood Conservation CPGs post intervention.

Additionally, there was a reduction in utilization of packed red blood cells (PRBCs) of 8.4% for coronary artery bypass (CAB) and 15.2% for CAB/valve replacement procedures noted post intervention.

Abstract

References Ferraris, et al., (2011). 2011 Update to the society of thoracic surgeons and

the society of cardiovascular anesthesiologists blood conservation clinical practice guidelines. Annals of Thoracic Surgery, 91(3), 944-982.

Maddox, et al., (2009). Institutional variability of intra-operative red blood cell utilization in coronary artery bypass graft surgery. American Journal of Medical Quality, 24(5), 403-411.

Snyder-Ramos, et al., (2008). The ongoing variability in blood transfusion practices in cardiac surgery. Transfusion, 48, 1284-1299.

Vidant Medical Center • Greenville, NC

Outcomes

100

200

300

400

500

600

700

Q1 2013 N=243

Q2 2013 N=239

TEG Started

Q3 2013 N=227

Q4 2013 N=272

Q1 2014 N=209

Q1 2014 N=189

Total Blood Product Transfusion Volumes for all Procedures Q1 2013 -‐ Q4 2014

CRYO FFP PLT RBC

53% 46%

90% 83%

20%

40%

60%

80%

100%

Pre (2011 - Q2 2013) Post (Q3 2013 - Q2 2014)

PRBC Use Pre and Post

CAB AVR+CAB,MVReplace+CAB,MVRepair+CAB

Institutional data from 2011 & 2012 reveals blood utilization for coronary artery bypass (CAB) & CAB/valve replacement procedures 6-11.6% higher than like academic medical centers and the Society of Thoracic Surgery (STS) benchmark.