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The blood utilization calculator, a target‐based electronic decision support algorithm, increases the use of single‐unit transfusions in a large academic medical center
Author(s) -
Connor Joseph P.,
Raife Thomas,
Medow Joshua E.,
Ehlenfeldt Bradley D.,
Sipsma Kristen
Publication year - 2018
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.14637
Subject(s) - medicine , calculator , unit (ring theory) , hematocrit , psychological intervention , single center , blood transfusion , red blood cell transfusion , emergency medicine , algorithm , surgery , computer science , mathematics , mathematics education , psychiatry , operating system
BACKGROUND Electronic decision support has been used to reduce use of red blood cell (RBC) transfusion. With the goal of reducing transfusions, we modified our RBC orders to default to 1 unit. Next, we created a target‐based algorithm, the blood utilization calculator or BUC, to calculate a dose in units, based on initial hemoglobin or hematocrit and weight. STUDY DESIGN AND METHODS RBC orders defaulted to 1 unit in March 2016 and the BUC was implemented in July 2016. This gave three periods to compare old orders (before intervention), new orders (1‐unit default), and the BUC period. A hospital dashboard that tracks blood product orders was queried to determine changes in single‐unit transfusions between periods. Changes in transfusions were compared by analysis of variance. Acceptance of the BUC dosage recommendation was studied in both medical‐based and surgical‐based specialties. RESULTS The number of single‐unit transfusions showed significant increases after each of the two interventions studied from 247 ± 19 before interventions to 358 ± 19 and then to 445 ± 141‐unit transfusions/month (p < 0.0001). The ratio of 1‐unit to 2‐unit transfusions increased from 0.72 to 1.67 (p < 0.0001) and we observed a 19% overall reduction in units transfused. The BUC recommendation was accepted in 49% of orders. CONCLUSIONS One‐unit default orders and implementation of the BUC resulted in a significant increase in the use of single‐unit transfusions. Improvement in the rate of acceptance of the BUC recommendation should further increase the use of single‐unit transfusions.