Improving red blood cell orders, utilization, and management with point-of-care clinical decision support

• Published in: Transfusion (Philadelphia, Pa.) Pa.), 2015-09, Vol.55 (9), p.2086-2094
• Main Authors: McKinney, Zeke J., Peters, Jessica M., Gorlin, Jed B., Perry, Elizabeth H.
• Format: Article
• Language: English
• Subjects: Decision Support Systems, Clinical - standards; Erythrocyte Transfusion; Erythrocytes; Female; Humans; Male; Medical Order Entry Systems - standards; Order entry; Physicians; Point-of-Care Systems - standards; Retrospective Studies; Trauma Centers
• ISSN: 0041-1132; 1537-2995
• DOI: 10.1111/trf.13103

BACKGROUND The computerized order for red blood cell (RBC) transfusion within our electronic health record was redesigned with integrated clinical decision support (CDS) to reinforce our restrictive transfusion policy. These changes encouraged 1‐unit (1U) RBC orders, clarified hemoglobin (Hb) transfusion triggers, and discouraged unnecessary orders. This study assessed whether these changes resulted in durable effects on provider practices. STUDY DESIGN AND METHODS The study compared three 1‐year subperiods from August 2011 to August 2014, with each year corresponding to a historical control period, preintervention and postintervention years. This study analyzed ratios of 1U versus 2‐unit (2U) orders and the absolute rate of RBC orders, units charged, Hb transfusion triggers, repeat transfusion orders, and selected clinical indications both institution‐wide and across several subpopulations. RESULTS Our institution‐wide ratio of 1U versus 2U orders increased from 0.50 to 1.20 (p