REDCap–Turning off the Tap of Blood...
1
REDCap – Turning off the Tap of Blood Transfusion Dr Ed O’Loughlin, Nasir David, Kylie Symons, Dr Hamish Mace. Department of Anaesthesia and Pain Medicine. Fiona Stanley Hospital, Perth, Western Australia Patient Blood Management (PBM) and the treatment of perioperative anaemia is a proven intervention strategy using either oral or intravenous iron, to reduce the need for blood transfusions and improve outcomes for high risk surgical patients. REDCap has been integral in enhancing our PBM pathway for patients by providing clinicians as ‘central’ data source to store and analyse pathology data and to assist in the rapid diagnosis of patients with anaemia and/or iron deficiency. REDCap has also enabled our team to “Choose Wisely” and significantly reduce wastage in pathology testing through the use of algorithms and routinely collected pathology data. Introduction Aims Our key aims to improve our PBM programme were to: • Reduce or eliminate blood transfusions for patients undergoing high risk surgery • Reduce unnecessary pathology testing by using routinely collected data • Reduce the time to diagnosis from presentation • Reduce the ICT workload of clinicians • Reduce time taken to complete clinical audits of the system and enable constant QI. • Increase the throughput and optimisation rate for patients through safe, rapid diagnosis. Methods We developed our own web services that integrated directly into the Western Australia Department of Health information systems. These linked into Patient Booking and Waitlist, Pathology, Theatre Management System and Transfusion databases. We then created ‘smart’ web services that included decision assist algorithms to analyse historical pathology tests for patients and recommend only those additional new tests that were required based on this analysis. These web services were then used with the DDP (Dynamic Data Pull) feature of REDCap and also called from custom software using the REDCap API. Results References 1. National Blood Authority – Perioperative Guidelines 2. Farmer F, Tower S, Leahy, M, Hofffman A (2013). Drivers for change: Western Australia Patient Blood Management Program, Best Practice & Research Clinical Anaesthesiology, Volume 27, pp 43-58 GEKO no: 29239 Workflow using REDCap to determine tests for patient based on previous pathology history and determine if any intervention and optimisation is required before surgery. Rapid Quality Improvement REDCap used the various collected data patient data (e.g. pathology, urgency category) to generate via Conditional Logic, a recommended patient diagnosis based on the Australian National Blood Authority (NBA) PBM guidelines. Assisted Patient Triage The ad-hoc reporting features in REDCap, has empowered clinicians to generate their own Quality Improvement reports of patients treated via this programme. Surgical specialities are now easily reviewed as audit data can be retrieved in ‘seconds’ and used in evidence based policy and constant improvement changes within the organisation. This data was presented in a SQL format to TABLEAU. This tool allowed clinicians to easily view patients enrolled in the programme in real-time. Graphical Icons displayed by REDCap in forms based on parameters driven by conditional logic. Example TABLEAU Dashboard containing triaged patients REDCap being the central data source for all these patient inputs, allowed us to leverage this information quickly and efficiently rapidly reducing time to diagnosis and intervention time before surgery. As as result, we have been able to add more surgical specialities to the programme and have increased patient throughput by over 200% Key Outcomes • Rapid audits and drive continuous positive change. • Increased throughput of patients through the programme by 200%. • Greatly reduced pathology testing through real-time algorithmic analysis. • Significantly improved patient outcomes through rapid, safe diagnosis, intervention and optimisation. Enhanced Data Analysis REDCap data is also exported in real-time to TABLEAU for deeper analysis. The strength of being a central data source of all PBM patient information (surgery type and urgency, pathology, intervention protocols, intra op and post surgical data) has allowed us to build a highly response BI tool that only needs to querying a single data set. This has enabled us to look deeper into aggregated data in real-time. Deep analysis of our PBM patient data by many different metrics is used to constantly improve peri-operative care and process. TABLEAU BI tools are use to examine aggregated PBM Data.
Transcript of REDCap–Turning off the Tap of Blood...
REDCap – Turning off the Tap of Blood TransfusionDr Ed O’Loughlin, Nasir David, Kylie Symons, Dr Hamish Mace. Department of Anaesthesia and Pain Medicine. Fiona Stanley Hospital, Perth, Western Australia
Patient Blood Management (PBM) and the treatment of perioperative anaemia is a proven intervention strategy using either oral or intravenous iron, to reduce the need for blood transfusions and improve outcomes for high risk surgical patients.
REDCap has been integral in enhancing our PBM pathway for patients by providing clinicians as ‘central’ data source to store and analyse pathology data and to assist in the rapid diagnosis of patients with anaemia and/or iron deficiency.
REDCap has also enabled our team to “ChooseWisely” and significantly reduce wastage in pathology testing through the use of algorithms and routinely collected pathology data.
Introduction
AimsOur key aims to improve our PBM programme were to:• Reduce or eliminate blood transfusions for
patients undergoing high risk surgery• Reduce unnecessary pathology testing by
using routinely collected data• Reduce the time to diagnosis from presentation• Reduce the ICT workload of clinicians• Reduce time taken to complete clinical audits of
the system and enable constant QI.• Increase the throughput and optimisation rate
for patients through safe, rapid diagnosis.
MethodsWe developed our own web services that integrated directly into the Western Australia Department of Health information systems. These linked into Patient Booking and Waitlist, Pathology, Theatre Management System and Transfusion databases.
We then created ‘smart’ web services that included decision assist algorithms to analyse historical pathology tests for patients and recommend only those additional new tests that were required based on this analysis.
These web services were then used with the DDP (Dynamic Data Pull) feature of REDCap and also called from custom software using the REDCap API.
ResultsReferences1. National Blood Authority – Perioperative
Guidelines2. Farmer F, Tower S, Leahy, M, Hofffman A
(2013). Drivers for change: Western Australia Patient Blood Management Program, Best Practice & Research Clinical Anaesthesiology, Volume 27, pp 43-58
GEKO no: 29239
Workflow using REDCap to determine tests for patient based on previous pathology history and determine if any intervention and optimisation is required before surgery.
Rapid Quality Improvement
REDCap used the various collected data patient data (e.g. pathology, urgency category) to generate via Conditional Logic, a recommended patient diagnosis based on the Australian National Blood Authority (NBA) PBM guidelines.
Assisted Patient Triage
The ad-hoc reporting features in REDCap, has empowered clinicians to generate their own Quality Improvement reports of patients treated via this programme. Surgical specialities are now easily reviewed as audit data can be retrieved in ‘seconds’ and used in evidence based policy and constant improvement changes within the organisation.
This data was presented in a SQL format to TABLEAU. This tool allowed clinicians to easily view patients enrolled in the programme in real-time.
Graphical Icons displayed by REDCap in forms based on parameters driven by conditional logic.
Example TABLEAU Dashboard containing triaged patients
REDCap being the central data source for all these patient inputs, allowed us to leverage this information quickly and efficiently rapidly reducing time to diagnosis and intervention time before surgery. As as result, we have been able to add more surgical specialities to the programme and have increased patient throughput by over 200%
Key Outcomes
• Rapid audits and drive continuous positive change.
• Increased throughput of patients through the programme by 200%.
• Greatly reduced pathology testing through real-time algorithmic analysis.
• Significantly improved patient outcomes through rapid, safe diagnosis, intervention and optimisation.
Enhanced Data AnalysisREDCap data is also exported in real-time to TABLEAU for deeper analysis. The strength of being a central data source of all PBM patient information (surgery type and urgency, pathology, intervention protocols, intra op and post surgical data) has allowed us to build a highly response BI tool that only needs to querying a single data set.
This has enabled us to look deeper into aggregated data in real-time. Deep analysis of our PBM patient data by many different metrics is used to constantly improve peri-operative care and process.
TABLEAU BI tools are use to examine aggregated PBM Data.
