儿科临床决策支持:对红细胞输血的最佳实践警报的评估
Brian D Adkins1,2, Roberta Murfin2, Hung S Luu1,2
1Department of Pathology, University of Texas Southwestern Medical Center, Dallas, Texas, USA.
Vox sanguinis
|July 11, 2023
概括
实施电子健康记录预警系统改善了儿科患者对红细胞 (RBC) 输血最佳实践的遵守. 这种干预导致了持续的变化和RBC支出的显著成本节约.
科学领域:
- 儿科血液学 儿科血液学
- 医疗信息学 医疗信息学
- 临床决策支持系统 临床决策支持系统
背景情况:
- 目前的最佳实践建议红细胞 (RBC) 输血用于血红蛋白<7g/dL的儿科患者.
- 在卫生系统层面确保适当的红细胞输血可能是具有挑战性的.
- 电子健康记录 (EHR) 临床决策支持系统可以促进对输血指南的遵守.
研究的目的:
- 评估EHR中的中断性最佳实践警报 (BPA) 对儿科医疗保健系统中红细胞输血实践的影响.
- 评估BPA实施后红细胞输血量和相关成本的变化.
主要方法:
- 基于血红蛋白值 (<8 g/dL,后来<7 g/dL) 的住院红细胞输血在EHR中实施了中断性BPA.
- 该系统要求医生在输血订单开始之前做出反应.
- 关于BPA激活,红细胞输血和医院指标的数据从2018年到2022年收集,与前两年相比.
主要成果:
- 在4年内,BPA激活了6956次,成功率为14.5% (24小时内没有输血).
- 在实施后观察到总红细胞输血和每次入院红细胞输血的非显著下降趋势.
- 估计在四年内节省的成本达到了213,822美元,平均每年51,891美元.
结论:
- 最佳实践警报的实施促进了对红细胞输血实践的持续变化,使其朝着既定的准则发展.
- 干预导致了与RBC支出相关的长期成本节约.
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