Optimizing Inpatient Blood Utilization Using Real-Time Clinical Decision Support

Area of Science:

• Hematology
• Medical Informatics
• Patient Safety

Background:

• Red blood cell (RBC) transfusion is a common procedure, but unwarranted transfusions in stable patients can lead to adverse events.
• Optimizing transfusion practices is crucial for patient blood management.
• A multidisciplinary, team-based approach is essential for improving transfusion outcomes.

Purpose of the Study:

• To develop and implement a real-time clinical decision support (CDS) tool to optimize RBC transfusion practices.
• To address the issue of unwarranted transfusions in hemodynamically stable patients.
• To integrate the CDS tool within an electronic health record system for real-time guidance.

Main Methods:

• A real-time CDS tool was developed, incorporating AABB transfusion guidelines.
• The tool was deployed as a dynamic order set within the computerized provider order entry interface.
• Provider engagement was enhanced through extensive education and outreach prior to launch.

Main Results:

• Guideline-indicated RBC transfusions increased from 43.6% to 54.2%.
• Multiunit (≥ 2 units) RBC transfusions decreased from 31.3% to 22.7%.
• An estimated minimum cost saving of $36,519.36 was achieved.

Conclusions:

• The CDS tool significantly increased guideline-indicated transfusions by 10.6% and reduced multiunit transfusions by 8.6%.
• A dynamic order set facilitated customized control of RBC orders, leading to sustained improvement.
• This intervention demonstrates the effectiveness of CDS tools in optimizing transfusion practices and patient blood management.