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Improving blood transfusion practice: role of a computerized hospital information system
E F Lepage1, R M Gardner, R M Laub
1Department of Biostaftistique et Informatique Medicale, Saint-Louis Hospital/University of Paris VI, France.
Insights
A computerized blood-ordering system improved transfusion practices by ensuring adherence to guidelines and reducing unnecessary orders. This system enhanced quality control and patient care in blood component transfusions.
Area of Science:
- Medical Informatics
- Health Services Research
- Transfusion Medicine
Background:
- Rising medical risks and financial costs necessitate improved blood transfusion guidelines.
- LDS Hospital implemented a computerized, knowledge-based system in 1987 to enhance transfusion quality and evaluation.
- The system flags transfusion requests that do not meet established medical staff criteria.
Purpose of the Study:
- To assess physician adherence to computerized transfusion criteria.
- To evaluate the impact of the system on the quality of transfusion practices.
- To measure improvements in institutional transfusion practices.
Main Methods:
- A retrospective review of 13,082 transfusion orders for 5,847 patients from July 1988 to June 1989.
- Analysis of adherence to computerized criteria for red cells, platelets, and fresh-frozen plasma.
- Evaluation of changes in mean hematocrit and quality assurance review rates post-implementation.
Main Results:
- High adherence rates: 91.2% for red cells, 72.9% for platelets, 81.7% for fresh-frozen plasma.
- Significant drop in mean hematocrit of transfused patients (28.6% to 27.7%).
- Reduction in quality assurance reviews from 100% to 14%, with a true-exception rate of 0.37%.
Conclusions:
- Computerized hospital information systems are effective for continuous quality improvement in transfusion practices.
- The system facilitated clear parameter setting for transfusions and improved institutional practice measurement.
- Implementation led to better adherence to transfusion guidelines and optimized resource utilization.
Abstract:
The recent focus on medical risk and financial cost has prompted a need for better guidelines for prescribing the transfusion of blood components. In 1987, to respond to the issues of quality transfusion practice and accurate evaluation, LDS Hospital (Salt Lake City, UT) began using a computerized, knowledge-based blood-ordering system. Each transfusion request was reviewed and flagged by the computer when it did not meet the criteria established by the medical staff. The study reviewed the use of red cells, platelets, and fresh-frozen plasma in 13,082 transfusion orders for 5847 consecutive patients from July 1, 1988, through June 30, 1989. The evaluation assessed, first, the adherence of physicians to computerized criteria and, second, their adherence to the quality of transfusion practice. A high percentage of the blood units ordered met the established criteria: 91.2 percent for the red cell transfusions, 72.9 percent for platelets, and 81.7 percent for fresh-frozen plasma. From the July 1, 1987, implementation date through June 1989, the mean hematocrit of persons being transfused dropped from 28.6 to 27.7 percent (0.29 = 0.28) (p less than 0.005) and the number of orders requiring review by the quality assurance department dropped from 100 to 14 percent; moreover, there was a true-exception rate of only 0.37 percent. The use of the computer system effected the implementation of the following measures: 1) identification of the indications and establishment of clear clinical and biologic parameters for every transfusion, and 2) measurement and improvement of institutional transfusion practice. These results demonstrated the efficacy of a computerized hospital information system in implementing continuous quality improvement for transfusion practice.(ABSTRACT TRUNCATED AT 250 WORDS)