Streamlining a blood center and hospital transfusion service supply chain with an informatics vendor-managed inventory solution: development, implementation, and 3-month follow-up.

BACKGROUND: The ordering process at Stanford Health Care involved twice-daily shipments predicated upon current stock levels from the blood center to the hospital transfusion service. Manual census determination is time consuming and error prone. We aimed to enhance inventory management by developing an informatics platform to streamline the ordering process and reallocate staff productivity. STUDY DESIGN AND METHODS: The general inventory accounts for more than 50 product categories based on characteristics including component, blood type, irradiation status, and cytomegalovirus serology status. Over a 5-month calibration period, inventory levels were determined algorithmically and electronically. An in-house software program was created to determine inventory levels, optimize the electronic ordering process, and reduce labor time. A 3-month pilot period was implemented using this program. RESULTS: This system showed noninferiority while saving labor time. The average weekly transfused:stocked ratios for cryoprecipitate, plasma, and red blood cells, respectively, were 1.03, 1.21, and 1.48 before the pilot period, compared with 0.88, 1.17, and 1.40 during (p = 0.28). There were 27 (before) and 31 (during) average STAT units ordered per week (p = 0.86). The number of monthly wasted products due to expiration was 226 (before) and 196 (during) units, respectively (p = 0.28). An estimated 7 hours per week of technologist time was reallocated to other tasks. CONCLUSION: An in-house electronic ordering system can enhance information fidelity, reallocate and optimize valuable staff productivity, and further standardize ordering. This system showed noninferiority to the labor-intensive manual system while freeing up over 360 hours of staff time per year.

Hepatitis B virus: a comprehensive strategy for eliminating transmission in the United States.

There is a global epidemic of hepatitis B virus (HBV) infections affecting more than 350 million people worldwide. This collective review provides the rationale for a comprehensive strategy to eliminate transmission of HBV in the United States. The virologic characteristics of HBV include three forms of HBV surface antigen (HBsAg), HBV core antigen (HbcAg), as well as a circulating peptide, the HBV e antigen (HBeAg). The year 2002 was the 20th anniversary of the use in the United States of the world's first vaccine against HBV. Our prevention strategy involves making HBV vaccine a part of the routine vaccination schedules for all infants in the United States. Hepatitis B immune globulin (HBIG) is another useful adjunct for prophylaxis that provides temporary protection (i.e., 3-6 months) and is recommended in only certain postexposure settings. The routes for administration of HBV vaccine and HBIG are intramuscular sites that differ according to the age of the individual. Following routine HBV vaccination in adults and children, prevaccination and postvaccination serologic testing is not recommended because of the relatively low rate of HBV infection and the low cost of the vaccine. Postexposure prophylaxis for HBV with serologic testing is, however, necessary for all hospital personnel exposed to blood or body fluids. In addition, infants born from mothers not immunized to HBV or those who are infected with HBV also require comprehensive postexposure prophylaxis with serologic testing. Comprehensive immunization strategies with serologic testing must be implemented for all groups that have a high risk of HBV infection. Finally, vaccine information statements (VIS) must be carefully integrated in this comprehensive disease prevention strategy, which is designed to prevent the transmission of HBV in the United States.

An evidence based alcohol screening, brief intervention and referral to treatment (SBIRT) curriculum for emergency department (ED) providers improves skills and utilization.

OBJECTIVE: Emergency Departments (EDs) offer an opportunity to improve the care of patients with at-risk and dependent drinking by teaching staff to screen, perform brief intervention and refer to treatment (SBIRT). We describe here the implementation at 14 Academic EDs of a structured SBIRT curriculum to determine if this learning experience improves provider beliefs and practices. METHODS: ED faculty, residents, nurses, physician extenders, social workers, and Emergency Medical Technicians (EMTs) were surveyed prior to participating in either a two hour interactive workshops with case simulations, or a web-based program (www.ed.bmc.org/sbirt). A pre-post repeated measures design assessed changes in provider beliefs and practices at three and 12 months post-exposure. RESULTS: Among 402 ED providers, 74% reported < 10 hours of prior professional alcohol-related education and 78% had < 2 hours exposure in the previous year. At 3-month follow-up, scores for self-reported confidence in ability, responsibility to intervene, and actual utilization of SBIRT skills all improved significantly over baseline. Gains decreased somewhat at 12 months, but remained above baseline. Length of time in practice was positively associated with SBIRT utilization, controlling for gender, race and type of profession. Persistent barriers included time limitations and lack of referral resources. CONCLUSIONS: ED providers respond favorably to SBIRT. Changes in utilization were substantial at three months post-exposure to a standardized curriculum, but less apparent after 12 months. Booster sessions, trained assistants and infrastructure supports may be needed to sustain changes over the longer term.