Optimizing Inpatient Blood Utilization Using Real-Time Clinical Decision Support.
Journal
Applied clinical informatics
ISSN: 1869-0327
Titre abrégé: Appl Clin Inform
Pays: Germany
ID NLM: 101537732
Informations de publication
Date de publication:
01 2021
01 2021
Historique:
entrez:
28
1
2021
pubmed:
29
1
2021
medline:
17
11
2021
Statut:
ppublish
Résumé
Red blood cell (RBC) transfusion is a common medical procedure. While it offers clinical benefits for many, hemodynamically stable patients are often subjected to unwarranted transfusions, with the potential to lead to adverse consequences. We created a real-time clinical decision support (CDS) tool in the electronic health record system to address this problem and optimize transfusion practice as part of an institutional multidisciplinary, team-based patient blood management program. The real-time CDS tool incorporated the transfusion guidelines published by the AABB. The tool was deployed as a dynamic order set within the computerized provider order entry interface. Prior to implementation, extensive education and outreach to increase provider engagement were provided. The CDS tool was launched in September 2015. The percentage of guideline-indicated RBC transfusions increased from a baseline of 43.6 to 54.2% while the percentage of multiunit (≥ 2 units) RBC transfusions decreased from 31.3 to 22.7% between September 2014 and July 2019. The estimated minimum cost saving over the entire study period was $36,519.36. Our intervention increased guideline-indicated transfusions by 10.6% and reduced multiunit transfusions by 8.6%. The adoption of a dynamic order set for the CDS tool, as opposed to an interruptive alert that displays static alert messages, allowed for more customized and tighter control of RBC orders, leading to a sustained improvement in our transfusion practice.
Sections du résumé
BACKGROUND
Red blood cell (RBC) transfusion is a common medical procedure. While it offers clinical benefits for many, hemodynamically stable patients are often subjected to unwarranted transfusions, with the potential to lead to adverse consequences. We created a real-time clinical decision support (CDS) tool in the electronic health record system to address this problem and optimize transfusion practice as part of an institutional multidisciplinary, team-based patient blood management program.
METHODS
The real-time CDS tool incorporated the transfusion guidelines published by the AABB. The tool was deployed as a dynamic order set within the computerized provider order entry interface. Prior to implementation, extensive education and outreach to increase provider engagement were provided. The CDS tool was launched in September 2015.
RESULTS
The percentage of guideline-indicated RBC transfusions increased from a baseline of 43.6 to 54.2% while the percentage of multiunit (≥ 2 units) RBC transfusions decreased from 31.3 to 22.7% between September 2014 and July 2019. The estimated minimum cost saving over the entire study period was $36,519.36.
CONCLUSION
Our intervention increased guideline-indicated transfusions by 10.6% and reduced multiunit transfusions by 8.6%. The adoption of a dynamic order set for the CDS tool, as opposed to an interruptive alert that displays static alert messages, allowed for more customized and tighter control of RBC orders, leading to a sustained improvement in our transfusion practice.
Identifiants
pubmed: 33506477
doi: 10.1055/s-0040-1721779
pmc: PMC7840436
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
49-56Informations de copyright
Thieme. All rights reserved.
Déclaration de conflit d'intérêts
None declared.
Références
Transfusion. 2014 May;54(5):1358-65
pubmed: 24117533
Oncologist. 2011;16 Suppl 3:3-11
pubmed: 21930829
Qual Saf Health Care. 2003 Dec;12(6):458-64
pubmed: 14645763
Am J Med. 2016 Jun;129(6):636.e13-20
pubmed: 26873112
ISBT Sci Ser. 2009 Nov;4(n2):423-435
pubmed: 32328164
Jt Comm J Qual Patient Saf. 2017 Aug;43(8):389-395
pubmed: 28738984
Am J Clin Pathol. 2019 Oct 7;152(5):544-557
pubmed: 31305890
J Am Coll Surg. 2009 May;208(5):931-7, 937.e1-2; discussion 938-9
pubmed: 19476865
Transfusion. 2015 May;55(5):1082-9
pubmed: 25488623
Transfusion. 2017 Apr;57(4):959-964
pubmed: 28035775
J Hosp Med. 2013 Sep;8(9):486-92
pubmed: 23956231
Transfus Med Rev. 2011 Jul;25(3):232-246.e53
pubmed: 21498040
Ann Intern Med. 2012 Jul 3;157(1):49-58
pubmed: 22751760
Transfusion. 2017 Jun;57(6):1347-1358
pubmed: 28150313
Transfusion. 2010 Apr;50(4):753-65
pubmed: 20003061