Variability in Blood and Blood Component Utilization as Assessed by an Anesthesia Information Management System

Frank, Steven M.; Savage, Will J.; Rothschild, Jim A.; Rivers, Richard J.; Ness, Paul M.; Paul, Sharon L.; Ulatowski, John A.

doi:10.1097/aln.0b013e318255e550

Cited by 171 publications

(141 citation statements)

References 36 publications

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“…Secondly, increasing evidence suggests that over-transfusion of allogeneic blood products is associated with increased morbidity and mortality due to infectious, immunological, pulmonary, and thromboembolic complications [5,6,7,8]. Especially worrisome is the substantial inter-institutional variability of transfusion practice, implicating high levels of insecurity regarding the indication for hemotherapy and potentially inappropriate usage [9,10]. Furthermore, it appears odd that hemoglobin levels of critically ill patients on intensive care units show a convergence over time, irrespective of the admitting hemoglobin level, age, and comorbidities [11].…”

Section: Introductionmentioning

confidence: 99%

Patient Blood Management Implementation Strategies and Their Effect on Physicians' Risk Perception, Clinical Knowledge and Perioperative Practice - the Frankfurt Experience

Fischer

Zacharowski

Müller

et al. 2015

Transfus Med Hemother

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Introduction: A multicomponent, evidence-based and interdisciplinary Patient Blood Management (PBM) program was introduced at the University Hospital Frankfurt in July 2013. The implementation strategy included practical and tactical components aimed to increase knowledge on the risks of preoperative anemia, to standardize hemotherapy, and to facilitate PBM components. Methods: This article analyzes barriers to PBM implementation and outlines a strategy to introduce and manifest PBM. The effects in Frankfurt were measured in a before and after questionnaire study distributed among groups of physicians immediately before and 1 year after PBM implementation. Results: 142 clinicians completed the questionnaire in July 2013 and 101 clinicians in August 2014. Absolute certainty that the treatment of preoperative anemia favorably influences morbidity and mortality rose from 25 to 37%. Transfusion behavior seems to have been affected: In 2014, 56% of clinicians stated that they clinically reassess the patient and analyze hemoglobin following each single red blood cell unit compared to only 38% stating this in 2013. Conclusion: These results show that our implementation strategy was effective in changing physicians' risk perception, attitude, and knowledge on PBM principles. Our experience highlights key success factors for the implementation of a comprehensive PBM program.

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Section: Introductionmentioning

confidence: 99%

Patient Blood Management Implementation Strategies and Their Effect on Physicians' Risk Perception, Clinical Knowledge and Perioperative Practice - the Frankfurt Experience

Fischer

Zacharowski

Müller

et al. 2015

Transfus Med Hemother

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“…The implementation of EHRs implicitly promised advanced data analytics to improve patient care and prevent unnecessary treatment [68]. The use of EHR systems [70,71,76,77] has enabled tailored feedback to the provider at the critical time of order entry to promote appropriate use [72,[78][79][80][81]. While several studies have shown beneficial impacts of CDS, large meta-analyses have failed to show a mortality benefit or meaningful impacts in reducing length of stay, adverse events, or costs [82][83][84][85].…”

Section: How Is Cds Effective?mentioning

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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“…[1][2][3] Although transfusion can be lifesaving in some clinical scenarios, most observational studies have shown a clear relationship between transfusion and adverse outcomes. [4][5][6][7] In prospective clinical trials that have compared liberal to restrictive transfusion strategies, the findings have revealed either no benefit [8][9][10][11][12] or increased morbidity and mortality 13 associated with increased use of transfusions.…”

Section: Introductionmentioning

confidence: 99%

Impaired Red Blood Cell Deformability After Transfusion of Stored Allogeneic Blood But Not Autologous Salvaged Blood in Cardiac Surgery Patients

Salaria

Barodka

Hogue

et al. 2015

Survey of Anesthesiology

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Background-Both cardiopulmonary bypass (CPB) and red blood cell (RBC) storage are associated with detrimental changes in RBC structure and function that may adversely affect tissue oxygen delivery. We tested the hypothesis that in cardiac surgery patients, RBC deformability and aggregation are minimally affected by CPB with autologous salvaged blood alone, but are negatively affected by the addition of stored allogeneic blood.

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Variability in Blood and Blood Component Utilization as Assessed by an Anesthesia Information Management System

Cited by 171 publications

References 36 publications

Patient Blood Management Implementation Strategies and Their Effect on Physicians' Risk Perception, Clinical Knowledge and Perioperative Practice - the Frankfurt Experience

Patient Blood Management Implementation Strategies and Their Effect on Physicians' Risk Perception, Clinical Knowledge and Perioperative Practice - the Frankfurt Experience

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

Impaired Red Blood Cell Deformability After Transfusion of Stored Allogeneic Blood But Not Autologous Salvaged Blood in Cardiac Surgery Patients

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