Situation

Patients with coagulation disorders undergoing surgery often require administration of factor products before or after surgery to prevent post-operative complications, such as bleeding. An opportunity exists to identify these patients as early as possible prior to surgery to coordinate medication therapy perioperatively.

Background and assessment

In 2022, HonorHealth spent approximately $3 million on a handful of patients with coagulation factor deficiency disorders requiring factor product administration post-surgery. The factor products cost $500,000 to $1 million per patient. Additionally, due to the DRG based reimbursement, HonorHealth would not get reimbursed for the cost of the factor products in the hospital. A team of pharmacy and perioperative leaders met to discuss opportunities to offset the costs related to factor product administration for patients undergoing elective surgery.

Recommendations/actions

• PATTs and perioperative teams will communicate with pharmacy leadership as soon as a patient with a history of coagulation factor deficiency is scheduled for an elective surgical procedure.
• The pharmacy department will notify case management to collaborate with the patient to bring in their own medication supply to be used in the hospital, or work with HonorHealth Specialty Pharmacy at John C. Lincoln Medical Center to dispense the products to the patient prior to the procedure.
• Perioperative leadership will communicate/educate surgeon’s offices to proactively identify these patients and to send orders/consult with hematology prior to surgery and coordinate obtaining supply of factor products prior to arriving at the hospitals.
• After surgery, patients can potentially be discharged early if surgically stable to complete the course of factor product administration post-operatively. Case management teams will facilitate coordinating factor products from the HonorHealth Specialty Pharmacy for expedited discharge.