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The Blood and Marrow Transplant Time out: Application of Universal Protocol As a Model to Improve Patient Selection-Suitability to Improve Allogeneic 1-Year Survivals

Year: 2019

Type: article

Abstract: Topic Significance & Study Purpose/Background/Rationale Patients being considered for allogeneic Blood and Marrow Transplant (Allo-BMT) undergo rigorous evaluations of which can influence Allo-BMT plan and outcomes. The goal of this project was to improve the patient selection process prior to admission for Allo-BMT. The process was modeled after the Universal Protocol (UP) used prior to surgery. UP is a National Patient Safety Goal, supported by Joint Commission, Institute of Medicine, and World Health Organization. Our center aimed to standardize the approach to determine patient suitability and treatment plan with the goal of improving 1-year survival. A UP approach was employed prior to BMT to secure consensus on patient suitability and treatment plan. Methods, Intervention, & Analysis A 1-page comprehensive BMT-Time Out (BMT-TO) checklist was created with critical domains selected to provide programmatic workflow (Figure 1). All Allo-BMT recipients underwent systematic BMT-TO reviews through progressive handoffs beginning July 2016. Checklists were audited monthly for completeness and adherence to standard operating procedures. Blood Marrow Transplant Information Patient System ("bmTIPS™") generated Allogeneic Transplant Intake Dashboard (ATID) reports, providing real-time numerical data on intake distribution patterns (Figure 2). The 2017 Allo-BMT 1-year survival data reported by Center for Blood and Marrow Transplant Research(CIBMTR) were used to set confidence levels and forecast CY18,19 projected 1-year survivals. Findings & Interpretation ATID for calendar years (CY)13,14, and 15, showed acceptance rates at presentation of 92%(n=98), 94%(n=105), and 77%(n=89), respectively. ATID for CY16, 17, 18 after implementation of BMT-TO showed lower acceptance rates: 83%(n=89), 86%(n=92), 85%(n=72), respectively. CIBMTR results showed improvement in our center's Allo-BMT 1-year survival rates with use of BMT-TO checklist (Figure 3): CY14(64%/reported); CY15=64%(n=45/reported); CY16=78%(n=28/reported); CY17=89%(n=37/predicted). Discussion & Implications Implementation of systematic review of patient selection-suitability data and BMT treatment plans using structured BMT-TO checklist before Allo-BMT, correlated with improved allogeneic 1-year survivals. Further evaluation and validation of the BMT-TO form is warranted.

Source: Transplantation and Cellular Therapy

DOI: 10.1016/j.bbmt.2018.12.191