Blood Management Strategies and Evidence-Based Blood Utilization [Interview][Transcript]

Joseph_Thomas_patient_Blood_ManagementGuest: 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, talks about a nationally recognized program that he developed built around safer, more evidence-based blood utilization.

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Neal Howard: Hello and welcome to Health Professional Radio. I’m your host Neal Howard, thank you for joining us today. Excessive amounts of blood transfusions have been recently found to be one of the most common medical errors. In a world where medical errors happen every day it’s kind of surprising that transfusions would be considered an error. Our guest in studio today is Mr. Jo Thomas, Registered Nurse and he’s here today to talk with us about a nationally recognized program that he developed and has built around safer, more evidence-based blood utilization. Welcome to Health Professional Radio Jo.

Mr. Joseph Thomas: Thanks for having me Neal.

N: Thank you so much. We’re talking about blood transfusions, this shortage that we’re experiencing is this something that we’ve seen before?

J: Yeah, we see blood shortages periodically and I guess many in the blood industry will argue, we’ve always got some type of shortage whether it be a specific blood product or a specific blood type but oddly there have been some cries for help from some of our largest blood providers like The American Red Cross that we are really and experiencing one of the worst blood shortages that we’ve seen in a while and it’s always for a variety of reasons but summer time never helps. Some of the Zika virus today and some of the concerns we have which has actually shut down collection in certain parts of the country, this along with the significant reduction in blood use causing blood providers to have to shift their practices of collection – all of this together has really contributed to again one of the worst blood shortages we’ve seen in a while.

N: Now you’ve got experience in both critical care nursing and patient blood management. How did you go from critical care nursing to focusing exclusively on blood management?

J: Yeah, I think that I said in the earlier interview sometimes your career chooses you, you don’t choose it. So I was a very happy Cardiothoracic ICU nurse at the Cleveland Clinic and it really due to a chain of events that sort of shaped my career, I was given an opportunity to pilot a program within that health system around bloodless medicine and surgery – really a novel program at that time. And again to keep it short over the years it expanded into patient blood management and I was able to serve as the director of that program within the Cleveland clinic health system. Ultimately given the chance with really a nationally recognized anesthesiologist Dr. Tim Hannon to help him with the startup consulting an analytics company in 2007 and then given a great opportunity by Accumen to really lead their effort around patient blood management and that over the past 14 years I arguably have as much as if not more experience than anyone in the world in implementing patient blood management programs so that now I worked with over 160 hospitals over that 14-year span.

N: So basically you’ve become an expert in patient blood management, you’ve used that term several times. What exactly is patient blood management and does it differ at all from just I guess regular blood management when the blood mobile is rolling down the street?

J: Sure, no it’s a fair question. I’ll start it with a provocative statement and that is first of all I believe, I’m not the only one but many of us believe that patient blood management is one of the five most important patient safety initiatives in this decade and that’s a powerful and certainly provocative statement. So patient blood management is more than simply managing a blood product or collection of a blood product. It is what we would call vein to vein transfusion safety, so from the vein of the donor to the vein of the recipient – it’s the right patient getting the right blood product at the right time for the right indication in the right dose. And I would arguably kind of summarize patient blood management as a couple of things, number one evidenced-based use of blood product, safe transfusion therapy and one area that often gets neglected but I think one of the most important aspects of patient blood management is simply that better management of the patient’s blood within their bodies. So establishing proactive strategies that are designed to eliminate or at least reduce the risk of transfusion and I’m sure we’ll talk about those like anemia management, minimizing bleeding and blood losses as an example.

N: Now better management often requires I guess better utilization of finances. Efficiency is one thing but are we talking reduction in cost and efficiency or are we trading out one for the other? Are we gonna spend more for better management?

J: Great question. This is actually one of those programs that is probably overused statements ‘win-win’ so we know that the better management of patient’s blood or a blood product certainly is preserving a precious and scarce resource, so it’s great for the community. But blood products aren’t free, it costs hospitals in the United States billions and that’s with a ‘B’ – billions of dollars to purchase blood products and that’s just to get them through the front door. It can costs billions of additional dollars to actually transfuse those blood products, process them and test them. So yes for those two things that you just said it is going to be certainly better utilization of a precious resource, it is going to often save a hospital millions of dollars but most importantly Neal why we care so much about this nationally today is that patient blood management is better for the patient. It actually has been shown to reduce the incidence of a variety of complications, improve patient outcomes and it truly is the standard of care today or the best available care that we can provide our patients, so that ‘win-win’ of saving dollars and improving the quality of care and that’s awesome.

N: Now you mentioned having the opportunity to head up a novel program some time ago but working with Accumen, you’ve developed a program that is well on its way to being instrumental in patient blood management. Talk about this program please.

J: Yeah, absolutely. So it was a lot of fun really in career to do this at one hospital or one hospital system, certainly one has recognized as the Cleveland clinic. What I’m really proud of in what we built at Accumen is that not only the people but the process and the technology to work with not only one hospital system but multiple hospital systems. In fact the last time I counted I think we now are currently working with around 70 different hospitals across the country. So that’s I think what certainly pleases me is the ability through Accumen have an impact on patient blood management nationally and arguably even internationally and so you go back to what I just said a moment ago it really what Accumen provides as the leading provider of patient blood management solution is nothing magical but really providing all of those tools and the resources that are immediately available to help a hospital or a health system rapidly accelerate their patient blood management program implementation. Whether it’s a new program or whether there’s already something in place we work with both and like we typically say at Accumen we provide the people over 75 or I think it’s 85 years of collective experience doing this. One hundred and sixty hospitals over the last 14 years, we have to process those playbooks, those specific plans having done this so many times to successfully and efficiently implement these programs. And then we have the technology really the analytic, the benchmark and the data to be able to rapidly change practice and provide our hospitals and providers the tools they need again to implement a successful program and change clinical practice.

N: Do you always find that the current blood management methodology is always inferior to the new? Or in your experience have you found that well ‘Maybe a piece of my program coupled with what they’ve already got will provide that efficiency and the savings in an adequate manner?’

J: Yeah, so Neal I think your question is well taken. It’s not so much that Accumen’s model is or that the hospital’s model was inferior, I would say that every hospital today in the United States is doing something around patient blood management. But what they’re missing often is that it’s really and successfully implemented comprehensive program, it requires dozens of different components and most hospitals only have either the time, the resources or the extra piece to implement some of those components. So I’m gonna give you one example most hospitals today I have changed their guidelines around the thresholds for when to order red blood cells. They’ve implemented guidelines, maybe they have some process to review or educate around those guidelines but that’s often where hospitals’ efforts and mainly due to not a lack of knowledge or interest but simply a lack of resources, time and expertise. So for instance we’re working with a number of health systems that’s already had, I think a very good program in play. What Accumen is going to do with them is take their program from good to great. We’re going to focus better platelet utilization, plasma utilization, cryoprecipitate, we’re gonna work with their teams to implement anemia management program and pre-operative anemia management programs. We’re gonna work with each of their high blood use specialties like cardiac surgery and trauma, critical care to minimize bleeding and blood loss and working with their pharmacy, their quality department as well as to provide really effective and meaningful data and analytic which will then help us prioritize where the focus needs to be and help us to show the vision and specialty that they report to where those opportunities for improvement are. So all of that I kind of Accumen helping hospitals go from good to great, helping them to develop, go from a blood management or red blood cell management program to a comprehensive patient blood management program.

N: And where can our listeners get more information about Accumen?

J: acumen.com and certainly Google us the nation’s leading provider and patient blood management, analytics and services.

N: You’ve been listening to Health Professional Radio. If you’re just joining us we’re in studio today with Jo Thomas, Registered Nurse and also currently Regional Director of Patient Blood Management for Accumen. It’s been great having you here with us today Jo.

J: Thanks for having me Neal.

N: Thank you. 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.

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