Implementing a Non-invasive Technology to Measure Hemoglobin for At-Risk Veterans
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Share PrintThe implementation of non-invasive, real-time hemoglobin monitoring as an innovative solution addresses the costly and discomforting aspects of laboratory testing, improving Veteran care. By adopting this technology, we can reduce phlebotomist touchpoints, minimize serial blood draws, increase patient comfort, and expedite clinical decision-making. The benefits extend to various settings within VA hospitals, including blood loss monitoring, surgical procedures, hemoglobin assessment, and home anemia monitoring.
Origin:
January 2021, Fayetteville VA Medical Center (Fayetteville, Arkansas)
Adoptions:
1 successful
Partners:
Systems Redesign and Improvement
Recent Updates
Overview
The problem
Laboratory testing costs trillions annually, with invasive and unnecessary blood draws causing discomfort and delaying clinical decision-making. This six-sigma lean green belt project aimed to identify the reliability and feasibility of using Non-invasive hemoglobin monitoring (SpHb) to identify anemia among at-risk hospitalized Veterans improve Veteran car
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Laboratory testing costs trillions annually, with invasive and unnecessary blood draws causing discomfort and delaying clinical decision-making. This six-sigma lean green belt project aimed to identify the reliability and feasibility of using Non-invasive hemoglobin monitoring (SpHb) to identify anemia among at-risk hospitalized Veterans improve Veteran care. This technology allows continuous or spot-check monitoring for individuals with recurrent bleeding, iron deficiency, or bleeding disorders. By adopting non-invasive hemoglobin monitoring, we can reduce phlebotomist touchpoints, minimize serial blood draws, increase Veteran comfort, decrease unnecessary blood transfusions, and expedite clinical decision-making. The benefits of this innovation extend to various settings within VA hospitals, including continuous monitoring for blood loss, surgical procedures with significant blood loss potential, hemoglobin assessment in the Emergency Department, home anemia monitoring for chemotherapy patients or those with chronic anemia, and facilitating the diffusing capacity of the lungs tests. Furthermore, this technology could have applications in Military Hospitals to monitor silent uterine rupture during Vaginal Births After Cesarean Section among military personnel or their dependents.
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The solution
SpHb is a feasible solution that reduces the need for frequent lab draws and improves turnaround time for anemia monitoring. By using SpHb instead of blood draws every 3-4 hours, the turnaround time (TAT) for anemia monitoring could potentially be reduced by 60%. SpHb provides continuous hemoglobin values that cannot be obtained through traditional blood lab
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SpHb is a feasible solution that reduces the need for frequent lab draws and improves turnaround time for anemia monitoring. By using SpHb instead of blood draws every 3-4 hours, the turnaround time (TAT) for anemia monitoring could potentially be reduced by 60%. SpHb provides continuous hemoglobin values that cannot be obtained through traditional blood labs. Hospitals and outpatient facilities would benefit from point-of-care technology like SpHb, as it can decrease the frequency of lab draws, lower costs, and minimize potential adverse events associated with invasive procedures.
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Videos
Above:
Improve Outcomes with Continuous Total Hemoglobin (SpHb®)
Above:
Rad-67™ Pulse CO-Oximeter® with Noninvasive Hemogobin (SpHb®) Spot-check Monitoring
The results
Among Veterans who were not fasting or dehydrated, a significant correlation (n=41, r=.78, p <.001) was observed between non-invasive hemoglobin monitoring (SpHb) [12.84 ± 1.69] and hemoglobin levels (Hgb) [13.20 ± 1.83]. This significant correlation means that the noninvasive tool is reliable decreasing the need for frequency of lab draws, lowering overall
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Among Veterans who were not fasting or dehydrated, a significant correlation (n=41, r=.78, p <.001) was observed between non-invasive hemoglobin monitoring (SpHb) [12.84 ± 1.69] and hemoglobin levels (Hgb) [13.20 ± 1.83]. This significant correlation means that the noninvasive tool is reliable decreasing the need for frequency of lab draws, lowering overall costs, and minimize potential adverse events associated with invasive procedures. The lab turnaround time for 24-hour monitoring, involving blood draws every 3-4 hours, averaged approximately 8.5 hours. In contrast, the average turnaround time (T.A.T.) for STAT labs was 42 minutes. Notably, non-invasive hemoglobin monitoring with SpHgb provided immediate value in delivering real-time hemoglobin measurements
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Files
- 2023 Study Statistics correlating with Descriptive statistics and correlations were used to identify agreement between SpHgb and lab hemoglobin values of this project findings. Accuracy of non-invasive hemoglobin level measurement in the emergency department
- Lean Six Sigma, Performance Improvement, R.O.I., and Literature Review Grand Rounds Presentation
Diffusion tracker
Does not include Clinical Resource Hubs (CRH)
Implementation
Timeline
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Week 1-3.
1. Initial Planning and Administrative Support:• Chief of Staff, Chief of Medicine, and Chief of Surgery provide administrative support and guidance. -
Week 4-5
2. Project Management and Data Collection:• VA Hospital Systems Redesign Coordinator assists with project management at their designated facility.• Utilization Management contributes statistical data from each VA Hospital.• Supervisory Inventory Management provides inventory information for cost analysis. -
Week 5
3. Approval and Equipment Management:• Medical Director gives final approval for ordering non-invasive monitors.• Medical Device Representative educates, orders, and follows up on equipment-related matters.• Supervisory Biomedical Engineer ensures proper inspection of devices before use.*This was the longest phase of my Green Belt project. -
Week 9
4. Education and Training:• Educate Phlebotomists, Nurses, Medical doctors, nurse practitioners, anesthesia personnel, and physician assistants on SpHb and its usage. -
Week 11
5. Communication and Data Collection:• Intensive Care Unit Manager, Emergency Department Manager, and Director of Clinical Laboratories facilitate communication and data collection. -
Week 14
6. Compliance and Privacy:• Privacy/FOIA Officer ensures compliance with veteran information privacy regulations. -
Week 20
7. Data Collection and Clinical Decision-making:• Phlebotomists collect data using the non-invasive hemoglobin monitor.• Nurses across various departments use the monitor for data collection.• Medical doctors, nurse practitioners, anesthesia personnel, and physician assistants make clinical decisions based on SpHb data. -
Week 25
8. Improved Veteran Care:• Veterans benefit from receiving non-invasive monitoring during their healthcare journey.
Departments
- Anesthesia
- Emergency care
- Intensive care unit
- Biomed
- Education and training
- Colon and rectal surgery
- Cardiovascular surgery
- Critical care
- Gastroenterology
- Hematology/Oncology
- Vascular surgery
- Surgical oncology
- Surgery
- Purchasing and supplies
- Pulmonary medicine
- Neurosurgery
- Nursing services
- Orthopedics
- Polytrauma and traumatic brain injury
- Plastic and reconstructive surgery
- Risk management
Core Resources
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Optional Resources
Files
- Project potential Return on Investment Project ROI Methodology
About
Origin story
I was working on my yearly Continuing Medical Education for Anesthesia when the topic of new technology came up. The literature discussed an innovative technology called non-invasive hemoglobin monitoring (SpHb), which immediately caught my interest. I was also pursuing my Lean Six Sigma Green Belt at the time. Recognizing the potential, I believed the non-i
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I was working on my yearly Continuing Medical Education for Anesthesia when the topic of new technology came up. The literature discussed an innovative technology called non-invasive hemoglobin monitoring (SpHb), which immediately caught my interest. I was also pursuing my Lean Six Sigma Green Belt at the time. Recognizing the potential, I believed the non-invasive monitor could be an excellent innovative implementation to reduce lab turnaround time (T.A.T.) and clinical decision-making time for medical interventions in Veterans admitted for Anemia caused by bleeding at V.H.S.O. I contacted V.H.S.O. Utilization Management to gather more information for statistical data on the number of labs drawn for the fiscal year, blood transfusions, and hospitalizations for recurring G.I. bleeding.
Initially, I was uncertain about the reliability and validity of the non-invasive technology beyond what I had read in the literature. Therefore, I contacted Masimo's local sales representative. Masimo kindly loaned me two continuous non-invasive monitors and one spot-check device for my Green Belt project. After conducting a T.A.T. examination, I requested permission from V.H.S.O.'s research and development to conduct a chart review of the Veterans' dehydration status who had lab draws. Dr. Jennifer Vincenzo then performed descriptive statistics and correlations to assess the agreement between SpHb and lab hemoglobin values, supporting my speculations. The analysis revealed there was a significant correlation (n=41, r=.78, p<.001) between SpHb [12.84 ± 1.69] and Hgb [13.20 ± 1.83] among Veterans who were neither fasting nor dehydrated. However, there was no significant correlation between fasting Hgb levels (n=17, r=.16, p=.53) obtained through lab draws [14.86 ± 1.25] and SpHb readings [12.67 ± 1.33]. Lab turnaround time for 24-hour monitoring, with blood draws every 3-4 hours, averaged around 8.5 hours, while the average T.A.T. for STAT labs was 42 minutes. It became evident that SpHb provided immediate and reliable value.
Following multiple discussions with Dr. Thomas Schiller, a V.H.S.O. Gastroenterologist, SpHb was adopted by Gastrointestinal M.D.s to monitor active G.I. bleeding in inpatients. Subsequently, through conversations with my anesthesia colleagues, we, as Anesthesia providers in the operating rooms, started utilizing SpHb to monitor patients with the potential for moderate to large surgical bleeding. However, one clinical leader resisted SpHb, claiming its utility was limited to certain subpopulations. To showcase the effectiveness of the Six Sigma Green Belt project, I presented my P.O.X. A3 to receive valuable feedback, which was overwhelmingly positive.
With the support of Tim Hagen, V.H.S.O. Systems Redesign Coordinator, and Tracie A. Story, V.I.S.N. 16 Systems Redesign Coordinator, I had the opportunity to present poster boards at the Institution for Healthcare Improvement Patient Safety Congress (2023) and the Healthcare Systems Process Improvement Conference (2023) on SpHb utilization. Additionally, thanks to Mr. Hagen and Mrs. Story's backing, I was invited to present at various important events, including the V.H.A. National Systems Redesign and Improvement team, V.I.S.N. 16 Leading Innovation Subcommittee Meeting, V.I.S.N. 16 Safety Forum, the H.R.O. On-Site Assessment Team Listening Session, Systems Redesign Steering Committee Meeting, Department Chiefs, and V.H.A. These invitations underscore the significance of this SpHb innovation and the interest stakeholders have shown in it.
Encouraged by Lisa M. Doyon (Interim Deputy Director, Systems Redesign and Improvement), Kristin Mate (G.C.V.H.C.S. Biloxi - MS-System Redesign Coordinator), Shenna Strong (Biloxi V.A.M.C. - Innovation Specialist ), and Elizabeth Williams (Biloxi V.A.M.C. - Innovation Specialist), I submitted my project to Diffusion Marketplace and Shark Tank These key stakeholders recognized the potential of this innovative technology for our Veterans and direct patient care providers. It offers a reliable and valid solution to address issues using a non-invasive, real-time hemoglobin monitor, enabling continuous monitoring or spot-checking for individuals with recurrent bleeding, iron deficiency, or any bleeding deficiency. This technology can reduce the number of phlebotomist touchpoints, minimize serial blood draws, increase Veteran comfort, decrease unnecessary blood transfusions, and improve clinical decision-making time. Additionally, there are potential intangible benefits such as reducing nosocomial infections, minimizing blood draws from central lines that could lead to central line-associated bloodstream infections (C.L.A.B.S.I.), and mitigating the risk of unintentional needle sticks among healthcare workers.
Original team
Ryan Vincenzo
Process Owner
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