Improved blood utilization using real‐time clinical decision support

Goodnough, Lawrence T.; Shieh, Lisa; Hadhazy, Eric; Cheng, Nathalie; Khari, Paul; Maggio, Paul M.

doi:10.1111/trf.12445

Cited by 127 publications

(173 citation statements)

References 58 publications

(84 reference statements)

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“…Therefore, the recommendation to establish an electronic order system is based on many theoretical but yet unproven advantages, such as adherence to guidelines, plausibility checks, data control, documentation, and storage-associated issues such as procurement. However, first attempts in Stanford, CA, and Minneapolis, MN, to install clinical decision support were promising [33][34][35][36].…”

Section: Discussionmentioning

confidence: 99%

Administration Safety of Blood Products - Lessons Learned from a National Registry for Transfusion and Hemotherapy Practice

Frietsch

Thomas

Schöler

et al. 2017

Transfus Med Hemother

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Background: Compared to blood component safety, the administration of blood may not be as safe as intended. The German Interdisciplinary Task Force for Clinical Hemotherapy (IAKH) specialized registry for administration errors of blood products was chosen for a detailed analysis of reports. Methods: Voluntarily submitted critical incident reports (n = 138) from 2009 to 2013 were analyzed. Results: Incidents occurred in the operation room (34.1%), in the ICU (25.2%), and in the peripheral ward (18.5%). Procedural steps with errors were administration to the patient (27.2%), indication and blood order (17.1%), patient identification (17.1%), and blood sample withdrawal and tube labeling (18.0%). Bedside testing (BST) of blood groups avoided errors in only 2.6%. Associated factors were routine work conditions (66%), communication error (36%), emergency case (26%), night or weekend team (39%), untrained personnel (19%). Recommendations addressed process and quality (n = 479) as well as structure quality (n = 314). In 189 instances, an IT solution would have helped to avoid the error. Conclusions: The administration process is prone to errors at the patient assessment for the need to transfuse and the application of blood products to patients. BST is only detecting a minority of handling errors. According to the expert recommendations for practice improvement, the potential to improve transfusion safety by a technical solution is considerable.

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Section: Discussionmentioning

confidence: 99%

Administration Safety of Blood Products - Lessons Learned from a National Registry for Transfusion and Hemotherapy Practice

Frietsch

Thomas

Schöler

et al. 2017

Transfus Med Hemother

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“…The experience of other hospitals/healthcare institutions shows that applying PBM principles throughout the entire perioperative period may decrease mortality [12,13], morbidity [12,14], in-hospital length of stay [12,13] and costs [15], allowing for a better use of medical resources [16], while maintaining patient safety [17].…”

Section: Premisesmentioning

confidence: 99%

Perioperative Patient Blood Management Programme. Multidisciplinary recommendations from the Patient Blood Management Initiative Group

2017

Rom J Anaesth Intensive Care

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Patients with untreated anaemia or iron deficiency who undergo surgical procedures have an increased risk for mortality and morbidity. Patient Blood Management programmes address this issue worldwide and try to improve patient outcomes through a complex set of measures targeting anaemia correction, minimisation of bleeding and improvement of anaemia tolerance, in all phases of perioperative care.The Patient Blood Management Initiative Group is a multidisciplinary team of physicians from specialties including anaesthesiology, nephrology, surgery, orthopaedics, haematology, gastroenterology and transfusion medicine. The team has elaborated ten recommendations, divided into five categories, in order to implement a Patient Blood Management programme in Romania, using the most recent and relevant evidence. The document was discussed during three meetings which took place during October 2016 and May 2017 and the result was modified and updated via e-mail.

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“…Additional benefits of our restrictive transfusion strategy included a significant improvement in the laboratory budget, with net savings of $1.6 million annually [93]. Purchase acquisition costs represents a fraction of total costs of blood transfusion that additionally include laboratory testing, reagent costs, nursing time dedicated to transfusion and monitoring.…”

Section: Improving Blood Utilization: the Stanford Experiencementioning

confidence: 99%

Is there a “magic” hemoglobin number? Clinical decision support promoting restrictive blood transfusion practices

Goodnough

Shah

2015

American J Hematol

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Blood transfusion has been identified as one of the most frequently performed therapeutic procedures, with a significant percentage of transfusions identified to be inappropriate. Recent key clinical trials in adults have provided Level 1 evidence to support restrictive red blood cell (RBC) transfusion practices. However, some advocates have attempted to identify a “correct” Hb threshold for RBC transfusion; whereas others assert that management of anemia, including transfusion decisions, must take into account clinical patient variables, rather than simply one diagnostic laboratory test. The heterogeneity of guidelines for blood transfusion by a number of medical societies reflects this controversy. Clinical decision support (CDS) uses a Hb threshold number in a smart Best Practices Alert (BPA) upon physician order, to trigger a concurrent utilization self‐review for whether blood transfusion therapy is appropriate. This review summarizes Level 1 evidence in seven key clinical trials in adults that support restrictive transfusion practices, along strategies made possible by CDS that have demonstrated value in improving blood utilization by promoting restrictive transfusion practices. Am. J. Hematol. 90:927–933, 2015. © 2015 Wiley Periodicals, Inc.

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Improved blood utilization using real‐time clinical decision support

Abstract: Real-time CDS has significantly improved blood utilization. This system of concurrent review can be used by health care institutions, quality departments, and transfusion services to reduce blood transfusions.

Cited by 127 publications

References 58 publications

Administration Safety of Blood Products - Lessons Learned from a National Registry for Transfusion and Hemotherapy Practice

Administration Safety of Blood Products - Lessons Learned from a National Registry for Transfusion and Hemotherapy Practice

Perioperative Patient Blood Management Programme. Multidisciplinary recommendations from the Patient Blood Management Initiative Group

Is there a “magic” hemoglobin number? Clinical decision support promoting restrictive blood transfusion practices

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