Significant reduction in red blood cell transfusions in a general hospital after successful implementation of a restrictive transfusion policy supported by prospective computerized order auditing

Abstract

Implementation of restrictive transfusion policy supported by prospective computerized order auditing has resulted in significantly decreased RBC utilization at our institution.

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

“…One center reconfigured their POE system for non-bleeding (excluding procedural units such as operating rooms, cardiac catheterization labs) patients to remove single-click ordering for 2-unit RBC transfusions; the provider must select from a drop-down menu if additional RBC units are desired. The proportion of 2-unit RBC transfusions decreased from 47% before to 15% after this intervention [96]. A second center similarly reported a reduction in 2-unit RBC orders (48% to 33%) and an increase in 1-unit RBC transfusions (22-48%), before and after, respectively, implementing a comprehensive education and audit program promoting restrictive transfusion practices [97].…”

The Impact of Electronic Decision Support on Transfusion Practice: A Systematic Review

“…Eight reported a statistically significant improvement in transfusion compliance after implementation of a DSS [8,14,[18][19][20][21][22][23]. One study [16] reported that there was no significant difference in compliance, and 2 studies [15,24] did not report any statistical analysis of their results.…”

“…Three of these studies reported a statistically significant reduction after DSS implementation [21,23,25]. In 2 studies, no statistical analysis was reported, but a trend toward reduction was shown [12,24].…”

“…Eight studies reported RBC transfusion compliance separately from other products. Seven studies reported a statistically significant improvement in RBC transfusion compliance with institutional guidelines after introduction of a DSS [14,[18][19][20][21][22][23], and the eighth did not report any statistical analysis [24]. One study reported plasma transfusion compliance separately, stating a statistically significantly improvement in compliance with a DSS [21].…”

“…Each of the 6 studies reported average hemoglobin or hematocrit values preceding RBC transfusion [11,12,21,[23][24][25]. Three of these studies reported a statistically significant reduction after DSS implementation [21,23,25].…”