Restrictive Transfusion Strategy and Clinical Decision Support Practices for Reducing RBC Transfusion Overuse

• Published in: American journal of clinical pathology 2019-10, Vol.152 (5), p.544-557
• Main Authors: Derzon, James H, Clarke, Nicole, Alford, Aaron, Gross, Irwin, Shander, Aryeh, Thurer, Robert
• Format: Article
• Language: English
• Subjects: Decision Support Systems, Clinical; Erythrocyte Transfusion - statistics & numerical data; Humans; Medical Order Entry Systems; Medical Overuse - prevention & control; Practice Guidelines as Topic; Quality Assurance, Health Care
• ISSN: 0002-9173; 1943-7722
• DOI: 10.1093/ajcp/aqz070

Abstract Objectives Assess support for the effectiveness of two separate practices, restrictive transfusion strategy and computerized physician order entry/clinical decision support (CPOE/CDS) tools, in decreasing RBC transfusions in adult surgical and nonsurgical patients. Methods Following the Centers for Disease Control and Prevention Laboratory Medicine Best Practice (LMBP) Systematic Review (A-6) method, studies were assessed for quality and evidence of effectiveness in reducing the percentage of patients transfused and/or units of blood transfused. Results Twenty-five studies on restrictive transfusion practice and seven studies on CPOE/CDS practice met LMBP inclusion criteria. The overall strength of the body of evidence of effectiveness for restrictive transfusion strategy and CPOE/CDS was rated as high. Conclusions Based on these procedures, adherence to an institutional restrictive transfusion strategy and use of CPOE/CDS tools for hemoglobin alerts or reminders of the institution’s restrictive transfusion policies are effective in reducing RBC transfusion overuse.