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Through a review of blood utilization in the surgical units, the administrative manager of
clinical operations for a large hospital noted what she believed to be a significant variation in the
number of transfusion orders being placed per surgical case among the surgeons on staff. She
brought the question to the surgical quality improvement committee, and the committee
initiated a review of current standard practice for ordering transfusions within the surgical units of
the hospital and also a review of best practices as supported by current research evidence. They
discovered that the evidence from transfusion research revealed that transfusion therapy can
result in a variety of adverse patient outcomes, including the transmission of infection diseases
and allergic reactions. As a result, the hospital medical staff moved to adopt as its general “best
practice” for transfusion ordering: a minimum hemoglobin concentration of 7g/dL (21%
hematocrit) as an indication for red cell transfusions and a 10g/dL hemoglobin
concentration (30% hematocrit) as a level at which transfusion therapy usually is unnecessary.After
the approved “best practice” guideline was introduced to the medical staff, a blood utilization
dashboard was developed that helps responsible clinical managers identify at the physician level
when transfusion orders are placed contrary to the guideline. Having this information available
enables the clinical manager to address the issue on a unit or with the individual physician
involved. Use of this dashboard has resulted in significant reduction in the variation in transfusion
ordering practices among the medical staff and a significant reduction in blood utilization, which
equates to a significant reduction in costs of maintaining the blood supply, and an
improvement in patient outcomes.
Questions:
1. What data elements must be accessed from the clinical data repository to drive the blood
utilization dashboard? Explain.
2. What clinical data systems might this data come from? Explain.
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