In order to measure program effectiveness, more than one measure, or metric should be chosen. The metrics used should match the intervention that is being targeted.
- The simplest metric is overall blood use. If this decreases, then there is the assumption that the program has been effective. However, this number is subject to a several confounding events. Should a significant event occur such as a liver transplant patient that used over 300 components during an admission occur, it could easily mask modest changes in ordering practices. In addition, significant changes in the number of patients being seen could cause the average usage to decrease in the face of no change in ordering practices.
- Blood use per patient admission is a better measure as it corrects for activity. But this measure is not perfect either. When blood use can be measured by clinical service and clinician, then it is easier to identify confounding events and make better assessments of actual behavior change.
- The cost of blood components used per month could be be useful as an overall measure, but is subject to confounding events and is less specific as some products such as plasma cost much less than platelet components.
In addition to blood usage data, metrics could include the number and/or percentage of patients who are:
a) seen in pre-op clinics,
b) have a preoperative hemoglobin of under a set value,
c) have predeposit autologous unit collections,
d) in the operating room and used hemostatic agents,
e) had blood specimens collected unnecessarily, and
f) receiving plasma as a method of warafarin reversal.
Images by Suzanne Butch
Comparing Blood Use by Physician. Prepared by Suzanne Butch