Mundell, William C.

Mayo Clinic adopted one electronic health record (EHR) across all 70 locations in five different states in 2017 and 18. A post-implementation review addressed concerns, and new workflows, processes and functionalities were adjusted. A common issue raised by multiple departments related to difficulty in accessing the right referral orders. Referrals between departments at Mayo Clinic are orders driven; scheduling is dependent on accurate ordering. Mayo Clinic’s vast size and number of specialties resulted in a very large catalogue of referral orders mapping to appointment types specific to each specialty. Providers found ordering in the new system time-consuming and looking for specific orders tedious. Often, wrong orders were selected, resulting in scheduling errors, reordering, rescheduling and staff and patient dissatisfaction. To solve this problem, an innovative functionality, EZ Panels, was created, which uses a panel-within-panel approach to group orders by speciality, displaying a much shorter list to providers. This functionality improved ordering capabilities, making it easier for providers to access the correct orders and make referrals accurately and efficiently. All 70 practices built and implemented EZ Panels in less than one year. Our fast-paced build and implementation approach can be modified and used by any healthcare system experiencing similar issues.

BACKGROUNDRecipients of hematopoietic stem cell transplantation (HSCT) are among the highest consumers of allogeneic red blood cell (RBC) and platelet (PLT) components. The impact of patient blood management (PBM) efforts on HSCT recipients is poorly understood.STUDY DESIGN AND METHODSThis observational study assessed changes in blood product use and patient‐centered outcomes before and after implementing a multidisciplinary PBM program for patients undergoing HSCT at a large academic medical center. The pre‐PBM cohort was treated from January 1 through September 31, 2013; the post‐PBM cohort was treated from January 1 through September 31, 2015.RESULTSWe identified 708 patients; 284 of 352 (80.7%) in the pre‐PBM group and 225 of 356 (63.2%) in the post‐PBM group received allogeneic RBCs (p < 0.001). Median (interquartile range [IQR]) RBC volumes were higher before PBM than after PBM (3 [2‐4] units vs. 2 [1‐4] units; p = 0.004). A total of 259 of 284 pre‐PBM patients (91.2%) and 57 of 225 (25.3%) post‐PBM patients received RBC transfusions when hemoglobin levels were more than 7 g/dL (p < 0.001). The median (IQR) PLT transfusion quantities was 3 (2‐5) units for pre‐PBM patients and 2 (1‐4) units for post‐PBM patients (p < 0.001). For patients with PLT counts of more than 10 × 109/L, a total of 1219 PLT units (73.4%) were transfused before PBM and 691 units (48.8%) were transfused after PBM (p < 0.001). Estimated transfusion expenditures were reduced by $617,152 (18.3%). We noted no differences in clinical outcomes or transfusion‐related adverse events.CONCLUSIONPatient blood management implementation for HSCT recipients was associated with marked reductions in allogeneic RBC and PLT transfusions and decreased transfusion‐related costs with no detrimental impact on clinical outcomes.