Efficacy of education followed by computerized provider order entry with clinician decision support to reduce red blood cell utilization

Zuckerberg, Gabriel S.; Scott, Andrew V.; Wasey, Jack O.; Wick, Elizabeth C.; Pawlik, Timothy M.; Ness, Paul M.; Patel, Nishant; Resar, Linda M.S.; Frank, Steven M.

doi:10.1111/trf.13003

Cited by 54 publications

(58 citation statements)

References 33 publications

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“…We were specifically interested in the CPOE with decision support along with education and audits and provider feedback on guidelines compliance. We have previously shown evidence to suggest that alerts by themselves may not have much impact, without education, audits, and provider feedback to support the alert message …”

Section: Discussionmentioning

confidence: 99%

Relative impact of a patient blood management program on utilization of all three major blood components

et al. 2016

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Section: Discussionmentioning

confidence: 99%

Relative impact of a patient blood management program on utilization of all three major blood components

et al. 2016

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“…However, with CPOE algorithms the overall decrease was 14.3%. They report that adding CPOE and clinical decision support did not further reduce RBC utilization and suggested education as an effective measure to reduce RBC utilization [17]. Our program only included adult inpatients.…”

Section: Discussionmentioning

confidence: 99%

Effectiveness of Provider Education Followed by Computerized Provider Order Entry Alerts in Reducing Inappropriate Red Blood Cell Transfusion

Patel

Rains

Clark

2016

Journal of Blood Transfusion

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To reduce the rate of inappropriate red blood cell transfusion, a provider education program, followed by alerts in the computerized provider order entry system (CPOE), was established to encourage AABB transfusion guidelines. Metrics were established for nonemergent inpatient transfusions. Service lines with high order volume were targeted with formal education regarding AABB 2012 transfusion guidelines. Transfusion orders were reviewed in real time with email communications sent to ordering providers falling outside of AABB recommendations. After 12 months of provider education, alerts were activated in CPOE. With provider education alone, the incidence of pretransfusion hemoglobin levels greater than 8 g/dL decreased from 16.64% to 6.36%, posttransfusion hemoglobin levels greater than 10 g/dL from 14.03% to 3.78%, and number of nonemergent two-unit red blood cell orders from 45.26% to 22.66%. Red blood cell utilization decreased by 13%. No additional significant reduction in nonemergent two-unit orders was observed with CPOE alerts. Provider education, an effective and low-cost method, should be considered as a first-line method for reducing inappropriate red blood cell transfusion rates in stable adult inpatients. Alerts in the computerized order entry system did not significantly lower the percentage of two-unit red blood cells orders but may help to maintain educational efforts.

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“…Physician compliance with clinical practice guidelines is, however, often incomplete, as multiple barriers limit guideline adherence. However, recently programs utilizing clinical decision support (CDS) directed toward more appropriate RBC transfusion practice have been successfully implemented and have been effective in reducing RBC utilization with equivalent or improved patient outcomes [22].…”

Section: Restrictive Transfusion Threshold/triggermentioning

confidence: 99%

“…a restrictive approach to RBC transfusion, a one-unit dose in nonbleeding patients, and avoiding "routine" daily lab testing in hospitalized patients) and proven tools (e.g. order sets and decision support) that can be used to reduce unnecessary and inappropriate transfusions [21][22][23] and reduce transfusion costs [7,[24][25][26].…”

Section: Effect Of Pbm On Costsmentioning

confidence: 99%

Transfusion Medicine: Time for a Change: Patient Blood Management and the Ontario ONTraC Program

Freedman¹

2016

J Perioper Crit Intensive Care Nurs

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Despite increasing recognition of the potential adverse effects of blood transfusion there is evidence that the procedure is over-utilized and often inappropriately and unnecessarily administered. Patient Blood Management (PBM) is a recent world-wide initiative to optimize transfusion therapy by employing preoperative and perioperative maneuvers and alternatives to avoid unnecessary blood transfusion. These approaches are, however, not restricted to the surgical setting, but may be applied whenever transfusion is contemplated. A key component of PBM is the appropriate management of anemia, a prime determinant of transfusion. Another is tolerance of anemia through the use of restrictive transfusion thresholds for transfusion and of a single unit at a time policy. Among a number of options at surgery, antifibrinolytics have proven effective at reducing blood loss and transfusion. Burgeoning literature demonstrates that PBM (also known as Blood Conservation or as 'Bloodless Medicine/Surgery') is costeffective while improving patient outcomes and conserving the blood supply. Data from the ONTraC program in Ontario are described herein to illustrate the effectiveness of PBM approaches.

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Efficacy of education followed by computerized provider order entry with clinician decision support to reduce red blood cell utilization

Cited by 54 publications

References 33 publications

Relative impact of a patient blood management program on utilization of all three major blood components

Relative impact of a patient blood management program on utilization of all three major blood components

Effectiveness of Provider Education Followed by Computerized Provider Order Entry Alerts in Reducing Inappropriate Red Blood Cell Transfusion

Transfusion Medicine: Time for a Change: Patient Blood Management and the Ontario ONTraC Program

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