Surgical Quality Collaborative Prompts Blood Conservation Measures at McLeod Health
One of the original participants in the S.C. Surgical Quality Collaborative, McLeod Health utilized the data-driven assessment tool to implement a number of patient safety and quality improvements, including a multi-year effort to change its blood-utilization numbers.
According to Emily Blackburn, general surgery data coordinator in the McLeod Quality Department, the ability to compare data and communicate regularly with the other participating hospitals provides a wealth of mutually beneficial information and the opportunity to tackle specific improvement projects.
Initially funded with the support of the BlueCross BlueShield of South Carolina Foundation and later The Duke Endowment, and formed in collaboration with SCHA, Health Sciences South Carolina, MUSC, and BCBSSC, the SC Surgical Quality Collaborative makes use of near-real time reporting of clinical data, metric dashboards, and other benchmark data to identify improvement opportunities and best practices. Using abstracted data from 25 random general surgery cases over an eight-day cycle, participating hospitals can drill down into every aspect of a patients care. Because all participating hospitals are working on the same procedures and using the same type of data and metrics, they can effectively collaborate and support each other in this work.
“One of (BCBSSCF) stipulations was to take the data and create quality improvement projects,” Blackburn said. “It’s more than just data and reports. It’s using the data to make quality improvements.”
In McLeod’s case, the first project was launched when they realized, based on quarterly reports, that they were utilizing more blood during and after surgeries than any other facility in the cohort.
“As we did a data dive into patients receiving blood, we broke it down,” she said. ”Are they being transfused pre-op, intra-op or post-op? The majority were being transfused after surgery.” Over time, McLeod implemented new protocols to help identify pre-op anemia earlier and took action to boost hemoglobin prior to surgery, which reduced the need for blood transfusions afterward.
“If you’re having bleeding colon cancer, obviously you have to go ahead with the surgery. Other categories can wait two weeks,” she said. “We’d had a blood conservation services department for decades and they were seriously under-utilized. They were thrilled to be engaged in the project,” she said. “They can engage at consult, work on getting their hemoglobin up, and follow-up with the patient after surgery.”
It may sound simple, but it actually required a culture change. Some surgeons were reluctant to change long-held practices. They hear “data” and “reports” and they automatically assume things are punitive. This is not a punitive thing at all. SCSQC isn’t about getting you in trouble. It’s truly about improving patient care, taking actionable and reliable data and implementing change to improve patient care.
“We had speakers come in through the collaborative, which is another great feature, and talk about new research and data that showed there are things in blood that are more harmful than helpful, and that we should limit the threshold of transfusion,” she said. The campaign also included educational materials in physician lounges and new order sets for ordering blood. “You literally had to only order one unit at a time, and list the indicator for transfusion,” she said. “It took a good year of doing all those things to see some results.”
Blackburn has since developed surgeon-specific reports for use with physician credentialing. “One of our physicians asked me for a timeline from March 2018 to the present, and one physician had reduced (the incidence of transfusion on abstracted cases) from 16 percent to 7 percent. A second one went from 9 percent to 3 percent.”
Less blood use also equals less blood waste, which saves money and ensures a better overall supply of blood products when they’re needed.
“This year’s project is focusing on opioid use reduction”, she said. Even in the midst of a pandemic, the hospital remains focused on continuous quality improvement, and the collaboration helps them maintain that focus.
McLeod’s surgeon lead, Dr. John S. Richey, is a major advocate for the program.
“The South Carolina Surgical Quality Collaborative provides the opportunity to allow its associated hospitals to share information and data which is beneﬁcial to patients statewide. The collaborative allows us to collectively identify areas in patient care warranting improvement. In certain areas of the surgical realm, we have been able to safely reduce patient hospital length of stay, thus improving patient outcomes. Notably, what myself and others are most excited about is the progress we have made in reducing postoperative opioid prescriptions. Despite the reduction in pills, we have still been able to adequately control the patient’s pain by making changes in the intraoperative and postoperative process. I look forward to what the future holds as we continue to collaborate as Surgeons of South Carolina to improve patient outcomes.”
Participating hospitals in the SC SQC include McLeod Health, MUSC Health, , Prisma Health Baptist Easley, Piedmont Medical Center, Roper Hospital, Bon Secours St. Francis Hospital, Roper St. Francis Mt. Pleasant Hospital, and The Regional Medical Center – Orangeburg.