Guest: Joseph Thomas, BSN, RN
Presenter: Neal Howard
Guest Bio: Joseph Thomas is a registered nurse and currently serves as Regional Director of Patient Blood Management (PBM) for Accumen. He has clinical experience in both critical care nursing and patient blood management program development. In 2002 he developed a nationally recognized program built around safer, more evidence-based blood utilization and served as Director of Blood Management for the Cleveland Clinic Health System until joining Strategic Healthcare Group (SHG) in 2007. From 2007 to 2013 he served as Vice President, Program Services for SHG.
Segment overview: Joseph Thomas, BSN, RN, discusses the benefits of patient focused blood management strategies.
Health Professional Radio – Blood Management Strategies
Neal Howard: Hello and welcome to Health Professional Radio. I’m your host Neal Howard, thank you so much for joining us today. By utilizing patient focused blood management strategies, health professionals can help health system save money while saving lives and also help to reduce nationwide blood shortages. Our guest in studio today is Jo Thomas, Regional Director of Patient Blood Management for Accumen and he’s here with us to discuss patient focused blood management strategies. Welcome to the program Jo.
Mr. Joseph Thomas: Thank you for having me Neal.
N: Thanks. Now you’re the Regional Director of Patient Blood Management for Accumen, talk about Accumen.
J: Yeah, absolutely. Well Accumen is an organization that was developed as really a focus on laboratory optimization for health systems across the country but a few years ago recognized early on that a big part of optimizing the lab would be patient blood management, improving blood utilization. So this has been a major focus of the organization is to establish the people, the process and the technology to be able to support our client hospitals and organizations throughout the country to implement a comprehensive patient blood management program.
N: I’m aware that nursing has specialties within the field. Your patient blood management, Director of patient blood management. Have you got any experience as to say an ER nurse or a critical care nurse? What is some of your background and how did you end up with Accumen as a Registered Nurse?
J: Yeah, not a lot of ICU nurses end up in the space of patient blood management. In fact there’s probably only a handful throughout the country but as they say sometimes your career chooses you versus you choosing it. So a very brief background that I’m Cardiothoracic ICU Nurse at the Cleveland Clinic, I was given an opportunity there to help really start a novel pilot program around bloodless medicine but quickly saw I think the need for it to expand into a more of a comprehensive patient blood management program and so for years I served as the Director of Patient Blood Management to or blood management at the time for within the Cleveland Clinic health system. I was given the opportunity to partner with a nationally recognized anesthesiologist, Dr. Tim Hannon years ago with a startup company and then I was given an amazing opportunity about three years ago by Accumen to really lead the vision and help to implement the people’s process and technology of our team. And so I guess they say arguably I have as much experience as anyone in the world but I’ve actually have the honor of working with now over 160 hospitals to implement patient blood management programs over the last 14 years.
N: Now when we’re talking about patient blood management, different uses I guess for the blood needs I guess different strategies for its management. Now you’ve developed a program that’s naturally recognized for patient blood management as you say was these well over a hundred hospitals in the United States. What does a blood management program entail?
J: Yeah, absolutely. Well let me make sure that I go back very quickly just to define what comprehensive patient blood management is for those who may not have heard the other interview and it’s evidence based utilization of blood products, so optimal transfusion therapy that sort of our first clinical concept. The second clinical concept is improving the recognition, diagnosis and management of anemia and then the third clinical concept is implementing strategies designed to reduce or eliminate bleeding and blood loss. Now scientifically that all makes perfect sense, the fact is though that it’s one of those factors where the whole is greater than the sum of its parts. Every hospital is doing something with those three clinical concepts that I defined but a comprehensive patient blood management program puts it all together and those types of programs are well-documented to often reduce blood utilization by 40, sometimes up to 60% which is incredible when you really think about it. So to answer your question now and I apologize Neal that I…for a moment but to answer your question I think of it in five buckets. One, infrastructure or kind of world class infrastructure and clinical champions. Two, evidence based transfusion guidelines with oversight and utilization of computerized division order entry and decision support. Three, technology, basically having a meaningful benchmarks, meaningful patient or a physician level, department level and hospital level data and analytics along with goals. Four, broad and effective clinical education and awareness campaigns and five, proactive strategies designed to reduce transfusion risk and this is more along those lines of having anemia management programs or organ multiple strategies throughout the hospital to minimize bleeding and blood loss. Again I went through those pretty quickly, we can certainly revisit any of those but all of those together even some of the boring stuff like infrastructure is critically important to implement a world class patient blood management blood program.
N: Let’s get into the some of the I guess some of the proof that’s in the pudding. Sometimes when you’re looking to change strategy, implement new programs, you just need someone to say ‘Hey, this is what happened with a client of mine or a friend of mine or a patient of mine’. Talk about Accumen’s success of the programs.
J: Yeah, absolutely. And I love what you said and that’s what I tell prospective partnerships, the proof’s in the pudding, please reach out to our health systems because they’ll tell you better than anyone the success of really the partnership. So we work with a number of very large health systems, with anything from 2 hospital health systems to 30 hospital health systems but one of my I call it ‘babies’ is a health system in the mid-west, 14 hospitals that really range from almost academic – liver transplants, heart transplant, bone marrow transplants even relatively small hospitals had been spending about thirteen or fourteen million dollars a year merely to purchase blood and was transfusing around fifty some thousand blood products every year. So as we started the program there we, number one as mentioned we put together the right infrastructure – a system stirring committee across the entire health system with representation from each hospital. Each of the hospitals had a committee or a taskforce, each of the hospitals had an executive sponsor, they had a physician champion, they had a project lead often someone from quality or nursing and that infrastructure was the beginning of the success. We implemented, updated their transfusion guidelines, we implemented those into their computerized physician order entry system, built in some decision supports to make it easier to do the right thing and harder to do the wrong thing when physicians went to order blood, the guidelines would be right there in their face and again defaulted and certainly built in some alerts to help ensure that physicians were making good decisions when they transfuse blood. Of course guidelines are guidelines, they could deviate by all means and sometimes patients need the guidelines to be deviated but again it helps physicians and providers make better decisions. They had a several metrics around how they ordered and when they ordered the different blood products, blood platelets, plasma and red cells and we work with the physician group leaders and groups to establish key metrics, key performance indicators along with goals and really kept those goals front and center with the providers. We gave over 200 presentations across that health system in 6 months to every single physician and nursing group that existed and we continued over the course of the last really two years now to roll out massive awareness campaigns with posters and fliers and pens really reinforcing the messaging and the changes that we wanted them to implement. And lastly we established a number of very proactive strategies, the preoperative anemia management program, working with their cardiac surgery and liver transplant teams to reduce again coagulopathies and bleeding. We also worked with some of their critical care groups to reduce the amount of blood that we draw off of their ICU patients and really a dozen other projects that I won’t bore you with but again it’s that overall process that within 18 months had reduced blood use by 43% and saving them for over 4 million dollars in just 18 months. It’s not just red cells, we’ve also reduced platelets and plasma significantly over that time into double digits. So again and we’re just getting started and that’s the scariest thing, is that a true comprehensive program as I’ve said from the beginning can absolutely reduce blood use by at least 40% and arguably some up to 60%.
N: That’s phenomenal. Where can our listeners get more information about Accumen?
J: acumen.com I hear it’s the best spot, Google us but certainly again for those health care providers who are administrators interested in learning more please do reach out to us, we’ll be happy to share more information.
N: It’s been great having you here in studio today with us Jo.
J: Thank you for having me Neal. It’s been a pleasure.
N: If you’re just joining us here listening to Health Professional Radio and I’m your host Neal Howard in studio with Jo Thomas, RN and Regional Director of Patient Blood Management for Accumen. He has clinical experience in both critical care nursing and patient blood management program development, a few years ago back in 2002 he developed a nationally recognized program built around to safer more evidence based blood utilization. Transcripts and audio of this program are available at healthprofessionalradio.com.au and also at hpr.fm and you can subscribe to this podcast on iTunes.