Electronic clinical decision support: Evidence that default settings influence end‐user behavior

Metcalf, Ryan A.; Goodfellow, Jason; Cail, Kelly; Blaylock, Robert C.; Kawamoto, Kensaku; Enniss, Toby M.; Galaviz, Charles; Lim, Ming Y.; Reddy, Santosh; Sharma, Vikas; Wanner, Nathan

doi:10.1111/trf.16269

Cited by 2 publications

(4 citation statements)

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“…This policy reduced RBC transfusion usage institution-wide by 11%. 14 The primary safety outcome was emergency-release RBC transfusion. Emergency-release transfusion included uncrossmatched RBC units, either O-negative or type-specific.…”

Section: Methodsmentioning

confidence: 99%

Transfusion Preparedness in the Labor and Delivery Unit

Benson

Metcalf

Cail

et al. 2021

Obstetrics &Amp; Gynecology

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OBJECTIVE: To evaluate patient safety, resource utilization, and transfusion-related cost after a policy change from universal type and screen to selective type and screen on admission to labor and delivery. METHODS: Between October 2017 and September 2019, we performed a single-center implementation study focusing on risk-based type and screen instead of universal type and screen. Implementation of our policy was October 2018 and compared 1 year preimplementation with 1 year postimplementation. Patients were risk-stratified in alignment with California Maternal Quality Care Collaborative recommendations. Under the new policy, the blood bank holds a blood sample for processing (hold clot) on patients at low- and medium-risk of hemorrhage. Type and screen and crossmatch are obtained on high-risk patients or with a prior positive antibody screen. We collected patient outcomes, safety and cost data, and compliance and resource utilization metrics. Cost included direct costs of transfusion-related testing in the labor and delivery unit during the study period, from a health system perspective. RESULTS: In 1 year postimplementation, there were no differences in emergency-release transfusion events (4 vs 3, P>.99). There were fewer emergency-release red blood cell (RBC) units transfused (9 vs 24, P=.002) and O-negative RBC units transfused (8 vs 18, P=.016) postimplementation compared with preimplementation. Hysterectomies (0.05% vs 0.1%, P=.44) and intensive care unit admissions (0.45% vs 0.51%, P=.43) were not different postimplementation compared with preimplementation. Postimplementation, mean monthly type and screen-related costs (ABO typing, antibody screen, and antibody workup costs) were lower, $9,753 compared with $20,676 in the preimplementation year, P<.001. CONCLUSION: Implementation of selective type and screen policy in the labor and delivery unit was associated with projected annual savings of $181,000 in an institution with 4,000 deliveries per year, without evidence of increased maternal morbidity.

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Section: Methodsmentioning

confidence: 99%

Transfusion Preparedness in the Labor and Delivery Unit

Benson

Metcalf

Cail

et al. 2021

Obstetrics &Amp; Gynecology

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“…Embedding randomisations efficiently into hospital transfusion systems will be challenging, and more clarity is needed on the optimal approaches for achieving this aim. 57,62 These new strategies provide a real opportunity to improve transfusion practice, which is viewed by patient and public members of our PPIE panel as an imperative for researcher teams, given their custodianship of public health data and blood as a donated altruistic resource. Collaborations with colleagues across the globe promote the building of a strong shared learning approach, so that challenges to the use of data are collectively addressed, to ensure improvements benefit both patients and blood donors in all settings, including low-resource country settings.…”

Section: H E L Pi Ng To Sh a Pe Th E Broa Der I N Te R Nationa L Effortmentioning

confidence: 99%

“…A focussed review on CDSS in transfusion described 20 separate studies, but nearly all studies were ‘before and after’ designs rather than randomised controlled trials or other more methodologically robust clinical trial designs 61 . The review concluded that while implementation of a CDSS might improve red blood cell usage, there were many uncertainties regarding the optimal features of these systems, 62 as well as their impact on cost savings, effects on patient outcomes and the sustainability of any effects. The authors also made recommendations for standardised reporting of outcomes, not least the nature of the algorithm used.…”

Section: Computerised Decision Support Systemsmentioning

confidence: 99%

“…These approaches are increasingly discussed in the literature and already used in public policy and in business to deliver cumulative improvements, for example companies ‘randomising’ potential customers to different presentations of online products to understand what drives purchases. Embedding randomisations efficiently into hospital transfusion systems will be challenging, and more clarity is needed on the optimal approaches for achieving this aim 57,62 . These new strategies provide a real opportunity to improve transfusion practice, which is viewed by patient and public members of our PPIE panel as an imperative for researcher teams, given their custodianship of public health data and blood as a donated altruistic resource.…”

Section: Helping To Shape the Broader International Effortmentioning

confidence: 99%

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Harnessing the potential of data‐driven strategies to optimise transfusion practice

Evans,

Murphy,

Foy

et al. 2023

Br J Haematol

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SummaryNo one doubts the significant variation in the practice of transfusion medicine. Common examples are the variability in transfusion thresholds and the use of tranexamic acid for surgery with likely high blood loss despite evidence‐based standards. There is a long history of applying different strategies to address this variation, including education, clinical guidelines, audit and feedback, but the effectiveness and cost‐effectiveness of these initiatives remains unclear. Advances in computerised decision support systems and the application of novel electronic capabilities offer alternative approaches to improving transfusion practice. In England, the National Institute for Health and Care Research funded a Blood and Transplant Research Unit (BTRU) programme focussing on ‘A data‐enabled programme of research to improve transfusion practices’. The overarching aim of the BTRU is to accelerate the development of data‐driven methods to optimise the use of blood and transfusion alternatives, and to integrate them within routine practice to improve patient outcomes. One particular area of focus is implementation science to address variation in practice.

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Electronic clinical decision support: Evidence that default settings influence end‐user behavior

Cited by 2 publications

References 3 publications

Transfusion Preparedness in the Labor and Delivery Unit

Transfusion Preparedness in the Labor and Delivery Unit

Harnessing the potential of data‐driven strategies to optimise transfusion practice

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