Effectiveness of clinical decision support in controlling inappropriate red blood cell and platelet transfusions, speciality specific responses and behavioural change

Abstract

Background Electronic clinical decision support (CDS) within Electronic Health Records has been used to improve patient safety, including reducing unnecessary blood product transfusions. We assessed the effectiveness of CDS in controlling inappropriate red blood cell (RBC) and platelet transfusion in a large acute hospital and how speciality specific behaviours changed in response. Methods We used segmented linear regression of interrupted time series models to analyse the instantaneous and long term effect of introducing blood product electronic warnings to prescribers. We studied the impact on transfusions for patients in critical care (CC), haematology/oncology (HO) and elsewhere. Results In non-CC or HO, there was significant and sustained decrease in the numbers of RBC transfusions after introduction of alerts. In CC the alerts reduced transfusions but this was not sustained, and in HO there was no impact on RBC transfusion. For platelet transfusions outside of CC and HO, the introduction of alerts stopped a rising trend of administration of platelets above recommended targets. In CC, alerts reduced platelet transfusions, but in HO alerts had little impact on clinician prescribing. Conclusion The findings suggest that CDS can result in immediate change in user behaviour which is more obvious outside specialist settings of CC and HO. It is important that this is then sustained. In CC and HO, blood transfusion practices differ. CDS thus needs to take specific circumstances into account. In this case there are acceptable reasons to transfuse outside of these crude targets and CDS should take these into account.

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“…The use of rigorous guidelines and clinical pathways has improved implementation of transfusion guidelines [ 22 , 23 ]. However, it is unclear whether a clinical decision system can also reduce the rate of RBC transfusion in hematology and oncology [ 5 ].…”

Advances in Clinical Decision Support Systems: Contributions from the 2022 Literature

“…Structural aspects include the type of CDS and clinical setting where the CDS was deployed or studied. Six studies included domain-specific systems such as an electronic alert to notify prescribers about inappropriate red blood cell and platelet transfusion [6]; a patient-specific CDS report for disease prevention and surveillance in the primary care setting [7]; a non-interruptive alert in anesthesia to reduce fresh gas flow when a predefined threshold was exceeded [8]; a real-time text message alert when antimicrobial therapy was inappropriate (i.e., an antimicrobial agent-pathogen mismatch with a positive blood culture result) [9]; a guideline-based CDS for maternal health [10]; and a microRNA-based thyroid molecular…”

Let Us Know Transfusion Triggers for Prophylactic Use of Platelet Concentrate—Analysis of Compliance with Recent Transfusion Guidelines in a Large Academic Medical Center

“…Implementing this method can lead to an immediate reduction of unnecessary blood components; however, the physician should be mindful of the potential for off-label use [ 30 ]. Even in the case of massive transfusions, CDS can contribute to improved patient safety, patient outcomes, and blood utilization [ 31 ]. These systems are enhancing adherence to transfusion medicine evidence [ 32 ].…”