Client Forum – Olympus osYris

Errors associated with blood transfusion procedures can have fatal consequences. In the UK surveillance procedures have identified mistakes in patient identification as the main factor in death and morbidity associated with the transfusion of incorrect blood components. In this edition of the HBSQuarterly we have the privilege of relaying the thoughts of Mr Andrew Dyckhoff, the Managing Director of Olympus UK on the company’s osYris product, a fully integrated suite of modular technology solutions for blood transfusion safety and blood product management.

Can you explain what osYris is and how does the offering change the way blood transfusions are handled in the UK?

Well, it covers the Olympus osYris product, offering essential process of work and execution.

Well, it changes really in two ways. One, it essentially guarantees a safe outcome to a transfusion and it does this by the intelligent use of technology. When you apply technology to a redesigned process, it allows you to make the process much simpler and in the case of blood transfusion working with the BTSH we have actually arrived at a technology supported 14 step process –the paper-based system was 27 steps. Secondly, combined with positive patient identification and use of technology to prompt and support the caregiver, means that the caregiver will always follow the right protocol first time and automated data capture means you will have full evidence of that.

Is patient safety recognised as a significant issue by caregivers in blood transfusion environments?

I think it is safe to say that transfusionists are generally very aware of patient safety and are very keen to improve safety in that environment. This seems to be an international phenomenon. We found it particularly important in the US where there is a very big interest and concern in patient safety in general, and specifically in terms of blood transfusions.

What are the current issues with regard to blood wastage and “overprescribing” blood? How does this precise technology impact upon this?

Well, there are definitely issues in North America and the UK. There is a significant overuse of blood. In the UK this was recognized in the Chief Medical Officers’ 2003 report where he identified it clearly as a priority. There is a belief, endemic in the healthcare system, that giving blood to the patient can never do the patient any harm and therefore if you talk to the vast majority of doctors they will always transfuse rather than not transfuse. There have been some detailed studies done over the last 10 or so years that have actually identified that transfusion in some cases, arguably is a primary indicator of a worse outcome in the critically ill. There was a paper on this issue published earlier on this year – there’s both the patient safety issue but also, throughout the world we face a decreasing donor pool. Add to this the incidents of HIV and other various diseases means that concerns with blood safety is a continuing trend and the likelihood is that other diseases will become known to us and the donor pool will shrink still further.

The cost aspect of this is really self-evident – if we are transfusing patients unnecessarily or inappropriately –that is a pure waste of a scarce, valuable and indeed expensive resource. The implications for UK hospitals is that they could save at least 10% of total blood budget and that is a significant number which any hospital Chief Executive would be interested in doing. An additional implication for us is that perhaps we could look forward to your other questions about patient safety –you know, do people put money where their mouth is in terms of personal safety. The UK government in the recent agenda for health going forward have identified 7 domains where they are engaging resources. The first of these is safety. The reality now is that when you go to hospital there is no budget for safety. Similar findings from the company Jako in the US are that people want to engage in projects that address the issue of patient safety but there is not money for patient safety per se.

The advantage of recognizing and introducing a safe and more efficient system reduces blood usage which mean the cost benefits you derive from that far outweigh the cost of implementation of patient safety. So, in effect, we have found a way to essentially what I call sometimes become the Holy Trinity which is supporting staff, protecting the patient and saving money in the process –so we essentially talk about it in terms of finding ways to make patient safety pay and that is why we think our approach is quite unique and exciting.

Are professional bodies in the NHS institutes introducing new protocols with regards to blood wastage?

No, not entirely. In the UK there are some very strong initiatives from the National Patient Safety Agency and also from the Department of Health .The National Patient Safety Agency initiative is headed by a Professor Lilleyman who is the Medical Director of NPSA and has identified as a priority the reduction of ABO mismatching. Similarly, in response to the EU directive which was published some 20 months ago and comes into law on 8th February, 2005, there are particular requirements around the audit and traceability of blood to the patient. The Department of Health has initially said that CPA accreditation covers you for most of the requirements of the legislation but for audit and flexibility article 14 and 15 are key areas. The Department of Health has formed a very eminent committee to make recommendation in this area. If you look more widely than this, then the story is very patchy – in the US there is a tremendous interest – the American Association of Blood Banks and the International groups are both very actively concerned with improving blood transfusion safety. However, in Switzerland there are no national guidelines so blood transfusions are left entirely up to the discretion of the individual doctor. In the UK there are very clear guidelines, which are nationally recognized.

What essentially osYris technology does is it creates better conformity with compliance because we prompt at the point of prescription and the doctor is able to check whether the indications or the criteria have been satisfied by the patient. Doctors can be much more confident in saying “well actually we do not need to transfuse this patient” and from cases in some hospitals in certain areas like Adult Intensive Care or in Cardiac Surgery, up to 50% of certain kinds of blood products are in fact inappropriately or unnecessarily confused. So we are talking potentially of a very significant impact. In essence if we can talk about the technology at this point, in terms of a case study conducted in Oxford, clearly the traditional route is to do this by training so that you make your clinical staff much better aware of what they should be doing and without a doubt if you train well and if you train regularly and you retrain at least annually you can make significant improvements and in the case of Oxford, in blood transfusion safety what they did was they did a controlled study by comparing an original manual process, initiating an intensive period of training, they then measured compliance at that point and with further training introduced the osYris technology and measured again. In a strict analysis of total compliance across all criteria –recording of frequencies and observations etc-the initial study based on the paper system showed a 12% compliance. With training that improved to 40% compliance. With technology that has been running for more than 2 years at a 100% compliance. So in terms of the training versus technology debate which is very active around the world, we would argue very strongly that without technology you cannot deliver 100% compliance, but that with technology appropriately applied - you most definitely can and we have evidence to back that up.

The training that you implemented at the Oxford site, was that done by Olympus people or do you encourage the institution to train themselves?

Our policy is very much what is traditionally known as “to train the trainer” – you know the training is not complex - it is largely around. There are really two elements and it is important to recognize that you do not just throw technology at an existing system. What you do is you use the introduction to technology as a reason to redesign the process and to redesign it specifically to operate with technology, and, in simple terms in the manual system if you have 4 alternative courses of action, one of which you are going to choose, to properly record it – you have to tick one and cross out the other three. If you are using technology you can automate that process by ticking 1 – you automatically exclude the other three and that is how they are able to reduce the number of steps in the process and the fewer steps means simple procedures which means faithful procedures. So you just have to educate staff to think of what they are doing in a slightly different way and to get them to trust the technology and that the outcomes will be what they think they are. Now, the really exciting thing from my point of view is that we found that this really enhances patient care because the carer no longer has to retain the process in the forefront of their mind and that frees up the capacity for them to focus on what they have to do, which is caring for the patient. People have described it in a number of ways – it makes them feel more confident and my favourite quote is “now I know I do a good job because now I can prove it”. Often nursing staff get unfairly blamed.

Another big issue which is fairly well documented now is distractions. A significant proportion of medical error occurs because the clinician is distracted during the care process and what we have identified is that if you deploy technology in that environment it creates a focus that means that the human being does not respond to the external interruptions and has a much higher likelihood of completion of the process from beginning to end when you use technology so there are many aspects to technology.

The other key thing to understand that after designing the system around technology the data that you capture is hugely valuable both in terms of transparency and in the ability to understand who is transfusing what and measure hospitals against their peer group and therefore create incremental improvements-but also it allows you to spot errors before they happen – and in one case where we had reported under the paper system that the blood bag number was being checked when we deployed the technology we found the particular staff were not scanning the blood bag number – they were scanning a different number. I think that this is a critical aspect. To the people who argue that paper is safe I would suggest that you cannot be sure that it is safe because people may actually say that they are checking it but unless you are using high tech equipment that monitors eye movement that proves which barcode they are looking at and it is an old rugby adage from my rugby coach that says “That what the eye does not see the heart does not read” and I think that people who still propose that paper is adequate are essentially kidding themselves because they are not aware of the true nature. Technology creates real transparency – it creates real proof that you did it right first time, the right caregiver to the right patient with the right product – and that is a critical aspect. But when you look at the whole system aspect if we deployed this kind of transfusion monitoring and safety technology nationally we could link that directly to the national blood service and have real time live data on the usage of blood and we could then streamline and prove the efficiency of our national blood stock management dramatically-we would only have to go and collect blood when a unit of blood had been used and this would dramatically and potentially reduce the wastage due to the collection of the wrong type of blood that are not used and then go out of date and then –the effect of national deployment has a hugely exciting potential in terms of meeting the issues of shortage of blood etc. and of course cost.

Could you expand more on the financial implications for individual institutions?

Yes, the cost of a blood bag in the UK is about £120 pounds. In the US it is around $300 and there are variations on that up and down, but blood products are expensive and a major trust with 80 odd wards across 4 hospitals is probably going to spend about £5 million a year on blood products. Now, roughly speaking to deploy blood transfusions faithfully would cost you between half a million pounds and three quarter of a million pounds-if you could reduce your blood usage by 10% that represents half a million pounds per annum saving so in terms of payback that is a pretty exciting proposition in terms of local medical environments and the really nice thing about blood transfusions is that because the blood transfusion data historically is recorded we can actually measure the actual transfusions in the past against national guidelines and come up with a tangible concrete figure as to the inappropriate usage which allows you to be very confident and totally measurement and evidence-based in terms of savings that you might and will achieve and certainly the Olympus approach is that we are not fighting to contract with hospitals sort of on risk sharing but more on a benefit sharing basis –because we are so confident that this is so real and we have the data to support it.

Are Olympus osYris seeking to partner or seek an and alliance with any other organization?

Yes. Olympus desires to be seen as expert players in a very particular niche and so we are actively seeking and in fact already are partnering with major players in this field and this area takes many years to get the system to be as simple as ours are to use and it is one of those curious thing is that the simpler it looks the more invisible the technology - the more work has gone into achieving that and there are many companies who are seeking to set out on this path, but from our experience it is a long task and a hard task and our proposal is that people should work with us and adopt the knowledge and experience that we have got – so I think it is fair to say that we are the world’s leaders now in transfusion safety and that has been recognized in various publications and around the world in terms of reputation. Therefore we would suggest that it is much better to adopt our technology and partner with us than go it alone and start again.

We have prevented a mishap-in Oxford we prevented a transfusion, which would have been fatal if it had gone ahead. Oxford has been running for nearly 3 three years now so in terms of our track record it is very strong.

Just one additional point which I think is well worth making is that Olympus are in partnership with the National Health Service and it is fair to say that we are an exemplar of public and private partnership as it is meant to be because Oxford supply the clinical knowledge and experience –we supply capital, the R and D capacity and the technology know how that support the re-engineering of the clinical process and in reality, without the achievements and without the leadership of the NHS in this field we would not be doing what we are doing and we very much see ourselves as-you know it is the NHS that have really done the invention – we are merely providing the technology to support the process and I think that is a good model for healthcare today. Every product that we develop we do in partnership with leading commissions in healthcare in the UK and increasingly throughout the world.