Christiana Care Health System has appointed 15-year Christiana Care veteran Brenda Rabeno, MBA, MLS (ASCP)CM, to the newly created role of transfusion safety officer, placing her in charge of a systemwide ongoing initiative to both monitor and guide the safe usage of blood products.
The position’s creation was a result of a Lean Six Sigma quality improvement project led by Christie Barnett, MICU physician assistant, and Adrian Fedyk, Finance program manager. The project resulted in a 75 percent reduction in non-guideline transfusions, an $800,000 annual savings in blood products and blood supplies and revealed significant cost savings opportunities for Christiana Care and for patients in the utilization of blood transfusion products. More importantly, the findings suggested those savings lay in the implementation of new outcomes-based guidelines on when and how much of a product to give to a patient.
“The medical field as a whole has been intensely reviewing practices in an effort to reduce waste while maintaining and even improving patient outcomes,” said Cheryl Katz, MS, MT, vice president, Pathology and Laboratory Services. She noted, for example, that when the American Board of Internal Medicine’s foundation asked representatives of medical specialties to contribute to its Choosing Wisely initiative, they dedicated one of the initiative’s five “Things Physicians and Patients Should Question” to the topic of when to transfuse.
“Our work around transfusions started in the medical ICU,” said Vinay Maheshwari, M.D., director of Medical Critical Care and medical director of Respiratory Therapy. “We understood the findings regarding best practices in utilization of blood transfusion products, but we also knew there was variation on how to implement and apply those practices. That warranted the creation of our blood management program, and that program needed a steward.”
That need led to a nationwide search that ultimately made its way back to Christiana Care.
“We interviewed many candidates and learned in our search that transfusion safety officers were quickly becoming a big recruitment goal for many organizations,” Katz said. “We couldn’t reach a consensus on any candidate until we reached out to Brenda. When the search team interviewed her, the best-case scenario fell into order.”
Rabeno is excited to direct her skills and experience to what she said is an important opportunity. Her goals include creating a dashboard powered by regularly and thoroughly gathered data, analysis of outcomes and education driven by those results.Katz said Rabeno’s leadership roles within Christiana Care made her the ideal selection. She began as a medical laboratory scientist in the blood bank before expanding Christiana Care’s flow cytomery section, developing its biorepository and supporting the advancement of translational cancer research in the Helen F. Graham Cancer Center & Research Institute, where the Cancer Genome Atlas project she led gained her national recognition.
“That’s a big component of it,” she said. “Our goal is to embed these new, outcomes-based standards in our culture. Those outcomes tell us that less can be more these days. Blood products are safer than ever, but transfusions are not risk-free. These guidelines are frequently being updated, and we are working to convey those updates to our physicians to ensure we are making evidence-based decisions and further reducing those risks associated with transfusing blood products.”