The physician compliance of red blood cell transfusion by computerized transfusion decision support system

Abstract

"When should we trigger a transfusion?" is always a critical question between the patient's benefits and risks in red blood cell (RBC) transfusion. A computerized transfusion decision support system (CTDSS) has been used since September 2004 in an academic medical center with 1400 beds. In this study, the factors affecting RBC transfusion were investigated. In total 20,551 RBC-transfusion episodes between January and December 2008 were reviewed. The nearest hemoglobin concentration before transfusion is defined as the transfusion trigger. The physician compliance, the factors associated with the transfusion triggers and posttransfusion hemoglobin increment were investigated. The physician compliance is 83.1%. The transfusion trigger is 8.32 ± 1.84 (mean ± standard deviation) g/dL. The transfusion triggers are statistically significant in terms of both different order sources and disease types (p<0.05).The posttransfusion hemoglobin level increased in two-thirds of the episodes. The percentages of hemoglobin increments after transfusion are dependent on the transfusion triggers. Appropriate transfusion practice may reduce the overuse of blood components and improve transfusion quality. CTDSS should be more powerful to intervene in the appropriateness of transfusion practice.

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

“…This can function as prospective computerized order auditing when coupled to current laboratory testing results. Physician compliance with hospital transfusion policy using CPOE coupled with decision support was shown to be 83% in one study …”

“…Physician compliance with hospital transfusion policy using CPOE coupled with decision support was shown to be 83% in one study. 22 Our hospital-based transfusion medicine service serves a 350-bed academic tertiary care medical center that includes a Level 1 trauma center, neonatal intensive care unit, and hematopoietic stem cell transplant program. Our hospital policy is to provide leukoreduced and irradiated RBCs for all patients regardless of age or diagnosis.…”

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

“…After full texts were examined, 24 records were judged to be eligible. Fourteen records excluded after examining full texts are shown in Supplementary Table S2 [32][33][34][35][36][37][38][39][40][41][42][43][44][45].…”

A Third of Perioperative Blood Transfusions in the ICU Does Not Follow Guideline Recommendations - A Retrospective Analysis

“…According to authors of a recent assessment, effective implementation strategies included multifaceted interventions, interactive education and clinical reminder systems. The latter in the field of transfusion of blood and blood products might be software based solutions such as a monitoring and feedback program [30] or software enforcing guideline adherence [31][32][33]. Also, an intensive workshop for a week, a "transfusion camp", was very successful for transfer of transfusion knowledge to clinicians [34].…”