Background:

Blood product transfusions are one of the most common therapeutic procedures performed in hospitalized patients. Currently, transfusion information is primarily available in UC San Diego’s electronic medical record, EPIC, in a “Transfusion” summary tab. Data available on this tab is incomplete and challenging to navigate. Furthermore, it is difficult to find pertinent blood product data and identify the status of blood product orders in an efficient manner, as data is dispersed throughout multiple locations in EPIC. As a result, delays in blood product transfusions are common. For instance, nurses and providers often call the Blood Bank directly to determine if ordered blood products have been prepared.  Not only does this increase the volume of tasks for clinical team members, the phone calls also disrupt the work of Blood Bank staff, affecting the turnaround time for all orders.  Consequently, blood transfusions may be delayed, at times with life-threatening or fatal consequences.  Another gap in the current EPIC layout is the absence of a quick way to determine if a patient has a history of red cell antibodies, transfusion reactions, or pertinent blood product restrictions.  Without this knowledge, providers may not be aware of patient-specific requirements or extended time required to procure compatible products, which may also delay patient care.   

Description:

The goal of this project is to create a “Blood Product and Transfusion Dashboard” within EPIC, to provide a more efficient way of gathering blood product and transfusion related data and, ultimately, to decrease delays in the transfusion workflow. This will be accomplished by synthesizing data populated in various areas of EPIC and presenting it to providers and nurses in a succinct and readily digestible manner (Figure 1). The dashboard will include pertinent hematologic lab data, with the patient’s hemoglobin, platelets, coagulation factors, haptoglobin, fibrinogen, and type and screen status. It will also include information regarding anticoagulant medications, presence of historical red cell antibodies, and if a consent for transfusion is on file. Beyond this, it will include more intuitive descriptions of product transfusion status: “Ordered”, “Being Prepared”, “Ready for Pickup”, “Transfusing”, or “Transfusion Complete”. Furthermore, the dashboard will leverage data that is actively entered into the patient’s medical record, such as when the clinical team scans a unit, initiates transfusion, and stops the transfusion.

Expected Outcomes:

Multiple benefits are expected with implementation of this dashboard, including decreased time from blood products being ordered to initiation of transfusion, decreased delays in initiating blood product preparation, and improved workflow for nurses, providers, and the Blood Bank staff when determining the status of a blood product order. Overall, these goals should lead to an increase in patient safety and fewer adverse outcomes related to delays in blood product transfusion.

Recommendations:

Next steps involve implementation of the dashboard, while obtaining both timestamp data from EPIC and user survey data to evaluate for potential decreased transfusion delays and improved user experience.