Digitally enabled hemovigilance allows real time response to transfusion reactions

Abstract

Background Transfusion carries a risk of transfusion reaction that is often underdiagnosed due to reliance on passive reporting. The study investigated the utility of digital methods to identify potential transfusion reactions, thus allowing real‐time intervention for affected patients. Method The hemovigilance unit monitored 3856 patients receiving 43,515 transfusions under the hemovigilance program. Retrospective comparison data included 298,498 transfusions. Transfusion medicine physicians designed and validated algorithms in the electronic health record that analyze discrete data, such as vital sign changes, to assign a risk score during each transfusion. Dedicated hemovigilance nurses remotely monitor all patients and perform real‐time chart reviews prioritized by risk score. When a reaction is suspected, a hemovigilance trained licensed clinician responds to manage the patient and ensure data collection. Board‐certified transfusion medicine physicians reviewed data and classified transfusion reactions under various categories according to the Centers for Disease Control hemovigilance definitions. Results Transfusion medicine physicians diagnosed 564 transfusion reactions (1.3% of transfusions)—a 524% increase compared to the previous passive reporting. The rapid response provider reached the bedside on average at 12.4 min demonstrating logistic feasibility. While febrile reactions were most diagnosed, recognition of transfusion‐associated circulatory overload demonstrated the greatest relative increase. Auditing and education programs further enhanced transfusion reaction awareness. Discussion The model of digitally‐enabled expert real‐time review of clinical data that prompts rapid response improved recognition of transfusion reactions. This approach could be applied to other patient deterioration events such as early identification of sepsis.

The incidence of transfusion‐related acute lung injury using active surveillance: A systematic review and meta‐analysis

“…It is thought that active surveillance can mitigate the problem of underreporting seen with passive surveillance. [14][15][16]94 This is why we elected to focus on active surveillance studies, while also analyzing passive surveillance to allow for comparison. Toy et al performed an active surveillance study at two centers where 10 cases of TRALI were identified out of 123,731 units transfused (8Á1/100,000) using donor risk mitigation practices during 2009.…”

“…This could take the form of broader implementation of active surveillance; however, in practice, active surveillance can be highly resource intensive, which presents challenges outside of a research setting. [14][15][16]94 Use of novel data-driven approaches to active surveillance of electronic health records, such as large language models or other machine learning methods could facilitate enhanced detection. 100 In conclusion, we used meta-analysis to obtain estimates for TRALI rates for RBCs, platelets, and plasma, by component transfused.…”

Improving our reaction time – Using technology to identify transfusion reactions sooner

“…15 In this issue of TRANSFUSION, Villamin et al take transfusion reaction surveillance to the next level. 16 They describe the roll-out of an active hemovigilance unit, which combines electronic vital sign change triggers with an action team available to respond to a possible transfusion reaction in real time. Using their EHR, they created a dashboard for tracking all transfusions as they are initiated for up to 6 h post-transfusion.…”

“…For example, the ordering of diphenhydramine or furosemide while a transfusion is occurring may indicate other patient symptoms requiring relief. 16 A nurse may document the presence of flushing or back pain in a clinical note an hour after transfusion. The use of correlate data for adverse event identification is already being used.…”

“…Additional data are present in the EHR that may also indicate the presence of a reaction. For example, the ordering of diphenhydramine or furosemide while a transfusion is occurring may indicate other patient symptoms requiring relief 16 . A nurse may document the presence of flushing or back pain in a clinical note an hour after transfusion.…”