SELF DISRUPTION IN HE ALTHCARE DELIVERY NET WORKS
VERAX Extending The Life Of Platelets And Protecting Patients BY CHARLES J. DICOMO, PHD | Administrative Director of Laboratory Services, Integration & Planning, WellSpan Health / MICHELLE ERICKSON, MD, MBA | Medical Director of Laboratory Services, Department Chair of Pathology & Laboratory Services, WellSpan Health / LISA SCHAEFFER, MT(ASCP) | Transfusion Services Manager, WellSpan Health
262
A LL SPI RE H E A LTH PA RTN E RS
SHARING STRENGTHS FOR BET TER HE ALTH
The demand for platelets is unpredictable for many health systems, especially those with an active trauma, surgical, oncology, or maternity service line. There needs to be a consistent supply of platelets available to handle emergency cases, yet not too much to create waste - both in the monetary sense and in product that requires the ongoing commitment of community donors. The problem is compounded by the short 5-day shelf life of the typical platelet product. Because platelets are kept at room temperature, they are the most prone to bacterial contamination with the potential to cause septic transfusion reactions in patients. WellSpan Health often experienced both surpluses and deficits of platelets over time. They wanted to create a more steady and reliable supply of platelets for their patients and did so by employing a test within their transfusion services laboratory that allowed them to rule out bacterial contamination, and thereby extend the life of their platelets. Michelle Erickson, MD, MBA, medical director of laboratory services and department chair of pathology and laboratory services; Lisa Schaeffer, MT(ASCP), transfusion services manager and Charles J. DiComo, PhD, the administrative director of laboratory services, integration and planning at WellSpan Health implemented platelet bacterial testing, using kits engineered by the Verax Biomedical company. Their Platelet Pan Genera Detection (PGD) test enables the blood bank to test for bacterial contamination at days 5, 6 and 7, with negative testing allowing the extension of shelf life up to 7 days. The patient benefits by receiving a product confirmed to be negative for bacterial contamination. The blood bank inventory has stabilized as products can be shelved for longer, making wastage much less likely. Approximately 25–30% of platelet transfusion patients are receiving Verax tested products, products that previously would have been wasted. The cost savings of utilizing these platelets is approximately $10,000 per month. Since deploying the Platelet PGD test, WellSpan now can improve access to platelets not just at the major hospital center, but also at their regional sister hospitals.
I N N O VAT I O N J O U R N A L 2 019
263
SELF DISRUPTION IN HE ALTHCARE DELIVERY NET WORKS
As with most blood banks, space is always at a premium, and there is never time to spare. Fortunately, the Verax test is simple to perform, takes only about 45 minutes and the Platelet PGD test requires a minimal footprint in the lab. No additional personnel was needed, and training was supported by Verax Biomedical. Implementation from start to finish was roughly two months with the company supporting new policy development as well as competency testing for WellSpan. Dr. DiComo also chairs the AllSpire Health GPO Laboratory Collaborative and shared his Verax experience with his colleagues. Seeing a 16-month savings through reduced waste of just over $205,000 for WellSpan Health, DiComo knew this would be of interest to this group to potentially deploy in their health systems' blood banks. Tower Health also deployed this system and showed similar reductions (see graphs). Other collaborative members are considering utilizing the test. Additionally, leveraging the size of the participating health systems, the collaborative was able to negotiate a favorable unit price for the Platelet PGD test.
264
A LL SPI RE H E A LTH PA RTN E RS
SHARING STRENGTHS FOR BET TER HE ALTH
Total Platelet Transfusions
Transfusions with Platelets Older Than Five Days 450 400 350 300 250 200 150 100 50 0
1400 1200 1000 800 600 400 200 0 Pre-Verax
Post-Verax
Pre-Verax
Total Number Platelets Outdated 350 300 250 200 150 100 50 0
Post-Verax
Total Number Platelets Outdated 30% 25% 20% 15% 10% 5% 0%
Pre-Verax
Post-Verax
WellSpan
Tower
WellSpan
Tower
WellSpan: Before Dates: 7/1/2015–6/30/2016 After Dates 7/1/16–6/30/2017 Tower: Before Dates: 1/1/2016–12/31/2016 After Dates 4/1/2017–12/31/2017
I N N O VAT I O N J O U R N A L 2 019
265
SELF DISRUPTION IN HE ALTHCARE DELIVERY NET WORKS
According to Dr. DiComo, “We now have a best practice for ensuring patient safety and extending platelets to days six and seven, which provides better resource management, saves money and most importantly supports us in delivering exceptional patient care.� The AllSpire Health GPO Laboratory collaborative is a uniquely engaged group that meets monthly to review upcoming GPO contract renewals as well as work collegially to share best practices, new innovations in the laboratory space and problem solve around laboratory challenges. It is comprised of administrative leaders from each of the participating health systems, including Veronica Fraser, director of laboratory services, Atlantic Health System, Adam S. Baldwin, regional lab director, Hackensack Meridian Health, Jon Morell, director supply chain management, Lehigh Valley Health Network and Ellen Kellom administrative director of laboratory services, Tower Health. These leaders share a commitment to stewardship of resources and continually strive to enhance the quality, safety and efficient delivery of laboratory services to the patients their health systems serve. This is just one example of the power of collaboration within AllSpire. Not only a cost savings exercise, this case also exemplifies using the principles of knowledge transfer to make care safer for the patients served as well as preservation of precious resources of the AllSpire communities. Photo from top to bottom Charles J. DiComo, PhD Administrative Director of Laboratory Services, Integration & Planning Michelle Erickson, MD, MBA Medical Director of Laboratory Services, Department Chair of Pathology & Laboratory Services Lisa Schaeffer, MT(ASCP) Transfusion Services Manager
266
A LL SPI RE H E A LTH PA RTN E RS