Effectively managing transfusion-free medicine patients and services during COVID 19

Significance and Background- Bloodless Medicine is a standard of care at Pennsylvania Hospital Education, patient identification, and care planning is facilitated through the Center for Transfusion-Free Medicine (CTFM) Onset of the COVID 19 pandemic necessitates social distancing, and protective strategies to minimize exposure and transmission (CDC, 2019) However, it is critical that we are providing vigilant, individualized, high quality care A virtual and telephonic workflow offers accessibility Purpose - The purpose of process change was to create a workflow to maximize access to patients and providers, while improving care delivery for patients refusing blood transfusion Interventions - CTFM maintains 250-400 patient encounters monthly The CTFM SOP was adjusted to accommodate a virtual and telephonic platform to meet with patients and providers In addition, patient identifiers physically and electronically in the EMR allow tracking of trends and outcomes Evaluation - Inpatient/face to face visits decreased 67% with the workflow adjustment and decreased hospital census Correspondingly, with the SOP changes, consultations increased 110%, monthly patient education sessions attendance increased 150% The ability to meet with patients utilizing videotelephone services increased accessibility for patients during limited contact, and those permanently confined to the home The CTFM nurse, coordinators, and secretary have been able to spend more time with patients, assisting in facilitating care and education Resulting in early enrollments and physician referrals Discussion -Prior to an enrollment, patients are provided a power point as a guide which covers an explanation of the hospital, CTFM department and services, blood fractions and treatments This guide is followed as a visual aid, during the virtual consultation for education and enrollment Education is provided throughout the service lines, and in each department Screening tools were created and placed at registration points to screen for potential “bloodless” patients, identifying those needing to be referred to CTFM These patients populate to a “bloodless” list created in EPIC Patient armbands, bed signs, and hard copies of enrollment forms were left at these registration points Enrollment forms were converted to e-documents Proactively, CTFM reviews the hospital OR list 4-6 weeks in advance and daily Innovation - Revision of the SOP provided insight into additional routes of outreach As a result, CTFM has been able to implement additional forms of service, provide education, and resources for patients Evaluation of this addendum to the SOP due to the current pandemic demonstrates the need to continue as an ongoing service permanently, as it contributes to the continuity of care