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Improved blood utilization using real‐time clinical decision support
Author(s) -
Goodnough Lawrence T.,
Shieh Lisa,
Hadhazy Eric,
Cheng Nathalie,
Khari Paul,
Maggio Paul
Publication year - 2014
Publication title -
transfusion
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.045
H-Index - 132
eISSN - 1537-2995
pISSN - 0041-1132
DOI - 10.1111/trf.12445
Subject(s) - medicine , hemoglobin , clinical practice , blood transfusion , emergency medicine , physical therapy
Background We analyzed blood utilization at S tanford H ospital and C linics after implementing real‐time clinical decision support ( CDS ) and best practice alerts ( BPAs ) into physician order entry ( POE ) for blood transfusions. Study Design and Methods A clinical effectiveness ( CE ) team developed consensus with a suggested transfusion threshold of a hemoglobin ( Hb ) level of 7 g/ dL , or 8 g/ dL for patients with acute coronary syndromes. The CDS was implemented in July 2010 and consisted of an interruptive BPA at POE , a link to relevant literature, and an “acknowledgment reason” for the blood order. Results The percentage of blood ordered for patients whose most recent Hb level exceeded 8 g/ dL ranged at baseline from 57% to 66%; from the education intervention by the CE team August 2009 to July 2010, the percentage decreased to a range of 52% to 56% (p = 0.01); and after implementation of CDS and BPA , by end of December 2010 the percentage of patients transfused outside the guidelines decreased to 35% (p = 0.02) and has subsequently remained below 30%. For the most recent interval, only 27% (767 of 2890) of transfusions occurred in patients outside guidelines. Comparing 2009 to 2012, despite an increase in annual case mix index from 1.952 to 2.026, total red blood cell ( RBC ) transfusions decreased by 7186 units, or 24%. The estimated net savings for RBC units (at $225/unit) in purchase costs for 2012 compared to 2009 was $1,616,750. Conclusion Real‐time CDS has significantly improved blood utilization. This system of concurrent review can be used by health care institutions, quality departments, and transfusion services to reduce blood transfusions.