Evidence-based red cell transfusion in the critically ill: quality improvement using computerized physician order...

Area of Science:

• Critical Care Medicine
• Health Informatics
• Evidence-Based Practice

Background:

• Implementing evidence-based practice in intensive care units (ICUs) presents significant challenges.
• Red cell transfusion protocols are crucial for managing anemia in critically ill patients.

Purpose of the Study:

• To assess the effect of an institutional protocol and computerized decision support on red cell transfusion practices in the ICU.
• To evaluate the impact of this quality improvement intervention on transfusion appropriateness and patient outcomes.

Main Methods:

• A multidisciplinary quality improvement intervention was implemented in a tertiary academic medical center.
• A comparison of care processes and outcomes was conducted during 3-month periods before and after the intervention.
• An evidence-based decision algorithm for red cell transfusion was developed using computerized provider order entry.

Main Results:

• The mean number of red cell transfusions per ICU admission decreased significantly (1.08 to 0.86 units).
• Inappropriate transfusions dropped from 17.7% to 4.5% (p < .001).
• Transfusion complication rates were reduced (6.1% to 2.7%, p = .015).

Conclusions:

• An institutional protocol combined with computerized decision support effectively reduced inappropriate red cell transfusions.
• This intervention improved transfusion practices without altering adjusted hospital mortality.
• Computerized provider order entry can facilitate the implementation of evidence-based transfusion guidelines.