Receive this Monthly Publication in your Inbox

    Never miss the latest in Healthcare Performance Insider by subscribing HERE!

    @Copyright 2019 - Healthcare Performance Insider a publication from Accumen, Inc

    Where should we send your newsletter?

    Privacy Policy: We hate spam and promise to keep your email address safe

    Stacey Valentine

    Profoundly Impacting Healthcare: Stacey Valentine, MD, MPH

    Global Impact: Rebecca Rock, RN and SABM CFO talks with HPI about two roles across two countries

    From Lab Trend Visionary to Dark Group CEO: HPI connects with the Founder and Editor of the Dark Report, Robert Michel

    Two Imaging Leaders, Two Systems, One Outcome: Communication

    From Communication Strength to Just in Time Reopening at MGH A conversation with Dr. James Brink, Chief of Radiology at Massachusetts General Hospital

    From Time Magazine to PBM Influencer: Sherri Ozawa's Mission to Define the Value of Blood

    Buried Blessings: Pandemic perspective from Tom Strauss, CEO at Sisters of Charity Health System

    Katie Castree, Career Healthcare Process Improvement Connoisseur

    Solving Lab Challenges through Recruiting Innovation: HPI connects with Lighthouse Lab Services President, Jon Harol

    Providing Value-Based Care in a Pandemic through Telehealth and Data Resources: An HPI exclusive with Dr. Darrel Weaver

    From Supply Chain Crisis to Innovation in a Pandemic

    From Navy Medic to running a Clinical Laboratory . . . during a pandemic

    Planning for Blood Shortages in a Pandemic with Dr. Claudia Cohn

    Blood Banking is more complex today than ever before. Rob Van Tuyle, President of Vitalant's Blood Division, tells us why.

    Profoundly Impacting Healthcare with Breakthrough Anemia Management

    Supporting Imaging Precisely Where You Need It

    Working Together Makes End of Life Conversations Easier to Have

    The Future of Imaging: Assessing the early impacts of COVID-19 and the path to innovation through Artificial Intelligence (AI) A conversation with Dr. Geoff Rubin

    Pivoting in a Pandemic: How a U.S. 3D printing manufacturer is helping healthcare in its time of need

    Mara G. Aspinall: Diagnostic evangelist educating the world on the power of diagnostics today

    How The Joint Commission is addressing the COVID-19 Pandemic

    CHI Nebraska’s Laboratory Director Connie Wilkins, describes How To Manage a Clinical Laboratory During the pandemic

    Former Commercial Lab Leader Highlights the Hospital Lab as the Solution to Community Sustainability in a Healthcare Crisis

    Three Phases Essential to Crisis Preparedness in Patient Blood Management with Anne Burkey of St. Luke's Health in Boise, ID

    The Importance of Agility in Your Lab

    Dr. Paul Biddinger Shares Three Ways to Prepare for COVID-19

    Bringing Clinical Skills to Operational Leadership During a Time of Crisis; Dr. Blanton, Chief Medical Officer at Peterson Health

    7 Team Attributes to Teams that Work in Challenging Times & Through Rapid Innovation

    From Finding Problems to Saving Lives: The Evolution of Interventional Radiology

    Identifying the Potential with AI in Radiology with Dr. Chung

    Communication in the C-Suite with Cliff Robertson of Catholic Health Initiatives

    Reviewing Your Patient Financial Journey with Melody W. Mulaik, President of Revenue Cycle Coding Strategies

    Ask An Accumen Expert: Carolyn Burns, MD, a Patient Blood Management Advocate

    Linda DeVee, Leads Radiology Services at Edward-Elmhurst Health

    Theresa Mouton, Market Chief Financial Officer with Steward Health

    PELITAS President and CEO Steven Huddleston Wants Patients to Have a Great Experience – Both Clinically and Financially

    How Do You Deal with 2 Billion Forms a Year? Ask Randy Campbell

    Medical Director of Telehealth for UAB Knocks Barriers Down to Treat Patients on Their Terms

    C-Suite Spotlight: Wayne Bohenek Chief Ancillary Services Officer, Bon Secours Mercy Health

    A Leader in the Laboratory Service Line : Pierre Mouawad

    Healthcare Partner: Autumn Farmer, Chief Laboratory Officer, Bon Secours Mercy Health

    How Imbio is using AI to close the gap of missed diagnosis with Mike Hostetler

    Spit Matters with Bill Phillips from Spectrum Solutions

    How COVID-19 inspired TeraRecon to accelerate their imaging solutions to the point of care with Jeff Sorensen

    Stacey L. Valentine, MD, MPH is a pediatric critical care physician at UMass Memorial Medical Center and an associate professor at University of Massachusetts Medical School. Her clinical interests include anemia, blood transfusions, and pediatric acute lung injury. She spoke with Healthcare Performance Insider about patient blood management initiatives that are moving the needle on transfusions for critically ill children.

    Dr. Valentine chose to pursue medicine early on, earning her medical degree from the University of Vermont School of Medicine, after which she pursued residency training at Boston Children’s Hospital for pediatrics. Throughout my residency, I was always drawn to pediatric critical care medicine, and I developed a passion for the physiology that I saw in the pediatric ICU. I pursued a fellowship at Boston Children’s and a subsequent career in pediatric critical care medicine. 

    During her residency and fellowship, Dr. Valentine took care of patients who made a significant impact on her. My experiences caring for patients led me to the interest in anemia, blood transfusion, and patient blood management. In particular, I had taken care of patients who I noticed were anemic because of the blood samples that we were taking from phlebotomy, and I couldn’t help but think, is there a way to be able to prevent that blood loss? That question resulted in her first peer-reviewed paper on the topic of minimizing phlebotomy-induced blood loss in critically ill children.

    Dr. Valentine began to focus more and more on ways to use patient blood management to not only treat anemia, but also to potentially avoid blood transfusions when possible. Of course, blood transfusions are absolutely necessary when they’re needed, and trying to figure out how to differentiate the necessary blood transfusions from the unnecessary transfusions was a keyway to improve patient blood management.

    The Pediatric Critical Care Transfusion and Anemia Expertise Initiative

    The Pediatric Critical Care Transfusion and Anemia Expertise (TAXI) was born out of discussions with the Pediatric Critical Care Blood Research Network. I had just finished as an invited expert in the Pediatric Acute Lung Injury and Consensus Conference, where I had developed guidelines for fluid and transfusion management in particular, in respiratory failure. And as my research group sat down, we thought, wouldn’t this be a wonderful thing to be able to do for the field of blood management, creating guidelines for transfusion in critically ill children? And using what I learned from my first Consensus Conference, we proposed using the same methodology for TAXI. Dr. Valentine co-led the initiative, the goal of which was to create international recommendations for transfusion in critically ill children.

    In order to do that, the TAXI team was committed to studying the evidence in order to make evidence-based recommendations. However, large, randomized control trials are not available in pediatric populations. The challenge was, how do we leverage having these world experts in the room to be able to create recommendations, really expert recommendations, when the evidence is not there? And then, when the evidence is not there, how can we align our research going forward to be able to answer those questions?

    TAXI led to the start of research into blood transfusions in pediatric critical care patients. The team also developed more than 100 recommendations, half research, half clinical. The most exciting part for me was creating the pediatric decision tree. In that decision tree, we were able to incorporate almost all of our recommendations into one place on one piece of paper. Pediatric critical care physicians across the world have that decision tree on the walls of their offices.

    The decision tree has impacted transfusion practice by giving the practitioner a way to follow through on their patients and determine where their patients fit. We really want to change the thought process of indications for transfusion, and especially that word “trigger versus threshold.” And what we emphasize quite a bit in TAXI is that, in good practice, you have to think about the entire patient and how your patient fits into the algorithm, and to use good clinical judgment. And for instance, what we wanted to say is that there’s a threshold potentially for transfusion and we don’t want one particular number, for instance, hemoglobin, to trigger that transfusion. Instead, think about that threshold of where you should consider a transfusion and also consider the clinical context as well, so that you’re not ordering blood products based on a number alone.

    While the first step of TAXI was to evaluate transfusion practices pertaining to red cell transfusions, the next steps are looking at transfusion practices for platelets and plasma in critically ill children. That initiative is the Pediatric Critical Care Transfusion Anemia Expertise Initiative-Control Avoidance of Bleeding, or TAXI-CAB. And with this, we are creating evidence-based, and when evidence is lacking, expert-based recommendations, particularly for platelets and plasma in critically ill children, and looking at that evidence and making recommendations when we can. And the hope is to be able to create a decision tree for our yellow products, or platelet and plasma, in children.

    For hospitals that haven’t created a patient blood management program yet, Dr. Valentine encourages them to think about creating a team that is interested and invested in patient blood management, including physicians, nursing, and executive teams. The team can then study the hospital’s current practice and compare them to national standards. It certainly takes investment, but once you start to break down each standard into individual pieces, it is certainly accomplishable. For guidance, look at resources from other hospitals that have created patient blood management programs, as well as other blood management resources out there to help you do this.

    Focusing on implementation leads to results

    My passion is to improve healthcare for children across the country and across the world. And the key part in looking at current practice and creating guidelines and recommendations, it’s really to be able to look at our current practices. What I want to do is impact that child at the bedside to improve their care.

    How can we leverage everything that we have in our resources to be able to do that? For me, the answer is looking at our current practice and asking, is our current practice what we should be doing? And if not, how can we develop recommendations to change our current practice?

    A critically important part of this process is implementation science. Creating recommendations and guidelines that are impractical to implement at the bedside does not actually improve care. Considering implementation also incorporates other questions, such as how can the recommendations that we create be implemented at the bedside? What are the barriers that caregivers face?

    And by doing that, according to Dr. Valentine, those recommendations that we create are actually implemented at the bedside and impact care. And I think that’s really, really crucial. Focusing on implementation helps to bridge the gap between what works for a single patient and what might work on a large scale.

    What I’ve been very passionate about is that you can create recommendations, but you have to make sure that these are able to be performed at the bedside and that your clinicians can use them and that they are effective. Because once they are, you can impact healthcare across the country and across the world.

    Stacey Valentine

    Stacey Valentine

    MD, MPH