Improving blood‐prescribing decisions: Evaluating the efficacy of a blood guidelines app

Abstract

Objectives: To assess the effect of an app providing national blood transfusion guidelines on prescribing decisions. Background: National, regional and local audits in England consistently show inappropriate use of all blood components; around 15%-20% of red blood cells (RBC) and 20%-30% of platelets and fresh frozen plasma (FFP). Hospital transfusion guidelines may be difficult to locate and not agree with national guidelines. We developed and tested a dedicated app providing national evidence-based guidelines for use at the point of care to help clinicians make better decisions when authorising blood. Methods/materials: We identified areas of blood authorisation with high frequency of component use and evidence of widespread unnecessary authorisation. We developed seven representative clinical scenarios where the transfusion of blood components may or may not benefit the adult patient. Responding doctors were invited to select their authorisation choice via an online questionnaire, initially without and then with access to the app. Adherence to guidelines was assessed with and without aid of the app. Results: Using the app, doctors were much more likely to select the correct decision, in accordance with national guidance. Compared with baseline measurements, decisions improved by 67% for RBC, 58% for platelets and 73% for FFP. These improvements were statistically significant. Conclusion: Apps such as "Blood Components" can help doctors do "the right thing rather than the wrong thing". Further studies are required to assess the impact of using the app in clinical practice and the effect on blood component management and financial savings.

Haemoglobin thresholds for transfusion: how are we doing in the era of Choosing Wisely? A retrospective cohort study

“…Continuing efforts are needed to support practising physicians by adhering to current guideline recommendations [39]. For example, computerised decision support using a smartphone app with the provision of evidence-based recommendations can improve adherence to transfusion guidelines [40]. Other interventions that can reduce the overuse of RBC transfusions among inpatients include education, combined with alerts in the electronic health record system [41,42], and audit and feedback [43], mostly implemented in multifaceted interventions [44,45].…”

Insights from developing and evaluating the NHS blood choices transfusion app to support junior and middle‐grade doctor decision making against guidelines

“…Since taking the App off the market following the simulated impact study, the App was not re‐issued for download, mainly due to resource constraints post pilot. However, the NHSBT's Patient Blood Management Team has since worked with clinicians and invested in other Apps, such as Blood Components 20 . In addition, there were imminent changes to the MHRA medical device regulations which need to be considered before re‐issue of a CE‐marked App.…”

“…However, the NHSBT's Patient Blood Management Team has since worked with clinicians and invested in other Apps, such as Blood Components. 20 In addition, there were imminent changes to the MHRA medical device regulations which need to be considered before re-issue of a CE-marked App. To minimise resource allocation, the Blood Choices App is being reviewed and will be made available for use as an educational, rather than a decision support, tool.…”

The Internet, Apps, and the Anesthesiologist

“…Other evolving point-of-care apps can automatically generate cardiac indices from a single snapshot of an arterial waveform or measure exact pupillary light reflex in unconscious patients [27,28]. The Point-of-care clinical support apps have been shown to improve skills in managing local anesthetic toxicity, malignant hyperthermia, and peri-operative blood prescribing [29][30][31][32]. This diversity makes point-of-care apps particularly useful to anesthetists who must be able to manage a broad array of problems across the physiological spectrum.…”