Paediatric clinical decision support: Evaluation of a best practice alert for red blood cell transfusion

Area of Science:

• Pediatric Hematology
• Health Informatics
• Clinical Decision Support Systems

Background:

• Current best practice recommends red blood cell (RBC) transfusion for pediatric patients with hemoglobin <7 g/dL.
• Ensuring appropriate RBC transfusion at a health system level can be challenging.
• Electronic health record (EHR) clinical decision support systems can promote adherence to transfusion guidelines.

Purpose of the Study:

• To evaluate the impact of an interruptive best practice alert (BPA) in an EHR on RBC transfusion practices in a pediatric healthcare system.
• To assess changes in RBC transfusion volume and associated costs following BPA implementation.

Main Methods:

• An interruptive BPA was implemented in the EHR for inpatient RBC transfusions based on hemoglobin thresholds (<8 g/dL, later <7 g/dL).
• The system required physician response before transfusion orders could proceed.
• Data on BPA activations, RBC transfusions, and hospital metrics were collected from 2018 to 2022, compared to the two years prior.

Main Results:

• The BPA activated 6956 times over 4 years, with a 14.5% success rate (no transfusion within 24 hours).
• A non-significant downward trend in total RBC transfusions and RBC transfusions per admission was observed post-implementation.
• Estimated cost savings reached $213,822 over four years, averaging $51,891 annually.

Conclusions:

• Best practice alert implementation facilitated sustained changes in RBC transfusion practices towards established guidelines.
• The intervention resulted in long-term cost savings related to RBC expenditure.