Improved blood utilization using real-time clinical decision support.

Area of Science:

• Healthcare Management
• Clinical Informatics
• Transfusion Medicine

Background:

• Blood utilization practices at Stanford Hospital and Clinics were analyzed.
• The study focused on the period following the implementation of clinical decision support (CDS) and best practice alerts (BPAs) within the physician order entry (POE) system for blood transfusions.

Purpose of the Study:

• To evaluate the impact of real-time CDS and BPAs on blood utilization.
• To assess the effectiveness of a standardized transfusion threshold in reducing unnecessary transfusions.

Main Methods:

• A clinical effectiveness team established transfusion guidelines with hemoglobin (Hb) thresholds of 7 g/dL or 8 g/dL for specific patient groups.
• An interruptive BPA within the POE system was implemented, providing literature links and requiring an acknowledgment reason for blood orders.
• Data on blood ordering and transfusion practices were collected before and after the intervention.

Main Results:

• The percentage of blood ordered for patients with Hb levels above 8 g/dL decreased from a baseline of 57%-66% to 52%-56% after an educational intervention, and further dropped to 35% after CDS/BPA implementation.
• Post-implementation, transfusions outside guidelines remained below 30%, with only 27% in the most recent interval.
• Between 2009 and 2012, total red blood cell (RBC) transfusions decreased by 24% (7186 units), despite an increased case mix index, resulting in an estimated $1,616,750 in savings.

Conclusions:

• Real-time CDS integrated with BPAs significantly enhances blood utilization efficiency.
• This concurrent review system offers a scalable model for healthcare institutions to reduce blood transfusions and associated costs.
• Quality departments and transfusion services can adopt similar strategies to optimize resource allocation.