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High-volume blood banks at academic hospitals and medical centers have increased demands for utilization review, which can be manual and laborious. Every blood bank’s utilization review program is unique and depends on available personnel, staffing, and access to electronic medical records. A standardized, automated workflow for utilization review can reduce error and subjectivity and maximize efficiency. A customizable query that can accommodate different product utilization review criteria and is compatible with mainstream EMRs such as Epic is a valuable clinical tool for many practice settings. Furthermore, an efficient workflow that minimizes manual technician review and reduces provider fatigue can provide increased cost savings while maintaining compliant utilization review practices. Modern versions of Microsoft Excel, the most used data spreadsheet program worldwide, incorporate new features for data collation and analysis, namely, Power Query. Power Query enhances Excel’s capabilities for self-service Business Intelligence (BI). We introduce an approach for Better Blood Bank Administration Review and Bridging Epic using QUEries (BB-BARBEQUE) and demonstrate a preliminary version of the workflow that enables ordinary end users, such as pathology residents, to conduct utilization reviews more easily and efficiently. The workflow is designed to dynamically capture product utilization data that are generated through Epic SQL reporting into a user-friendly spreadsheet format. The data are filtered by using customizable queries to capture blood product requests that are most likely to yield actionable results. Our reviews included blood product requests for units of packed red blood cells, platelets, fresh-frozen plasma, and cryoprecipitate, as well as extensive associated metadata, including the ordering unit, patient identifiers, provider names, dates and times of product use and laboratory collection, and most recent laboratory values for hemoglobin, platelet count, INR, and fibrinogen. We compare this approach to the previous, manual workflow. Incidences deemed inappropriate for product use are tracked and compared with both approaches, through a metric designed to evaluate the number of successful provider contacts, either through a form letter or telephone call. We also provide preliminary comparisons of technician time saved by adopting this procedure compared to the previous approach. Overall, we show that automation of key steps in the utilization review procedure can significantly increase efficiency while improving the end-user experience, and we demonstrate an end-user product that is translatable to many institutions using an Epic EMR backend.

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INTRODUCTION: Lymphocytic Esophagitis (LyE) is an increasingly recognized clinicopathologic entity with an emerging definition. A significant histologic and clinical overlap exists between LyE and reflux esophagitis (RE; however, no specific associations have been elucidated. Previous studies have shown that absence or decrease in the number of granulocytes in esophageal biopsies in patients with LyE have correlated with a different phenotypic presentation from reflux esophagitis, with more patients being predominantly older women with dysphagia. The aim of this study was to help differentiate the two entities based on their clinical characteristics. METHODS: A retrospective chart review was performed of all patients with a biopsy diagnosis of LyE between 2009-2018 at a large tertiary academic institution. Biopsies were then re-categorized into two groups: LyE with few granulocytes (LyE-FG), and reflux esophagitis with increased IELs (RE-IEL). Data regarding socio-epidemiologic, clinical, and histologic findings were collected. RESULTS: A total of 53 biopsies were reviewed (35 RE-IEL, 18 LyE-FG). Most patients were Caucasian- 78% and 75% in RE-IEL and LyE-FG groups, respectively (P = 0.559). Baseline characteristics were similar between the two groups (Table 1). Dysphagia was the most common symptom in both groups with 70.4% in RE-IEL and 75% in LyE-FG groups (P = 0.767) with heartburn being the second most common symptom (63% vs 60%; P = 0.850) respectively. More patients in the LyE-GF group had inflammatory bowel disease (17.6% vs 6.7%); however, this difference was not statistically significant (P = 0.241). A significant number of patients were on proton pump inhibitor (PPI) at the time of diagnosis (75.9% RE-IEL vs 80% LyE-IG; P = 0.756). Patients with RE-IEL were more often smokers (63.3% vs 40%); however, there was no statistical significance (P = 0.138). There was no statistical significance between rates of NSAID or alcohol use between the two groups. Site of biopsy was not statistically significant between the two groups (P = 0.306) with the majority of biopsies taken from the distal esophagus. CONCLUSION: Our study shows the clinical overlap between LyE-FG and RE-IEL. RE and LyE share significant histologic overlap; however, LyE is clinically characterized by dysphagia as the most predominant symptom compared to classic RE, where heartburn and regurgitation are more common.