Clinical decision support reduces overuse of red blood cell transfusions: interrupted time series analysis.
Am J Med. 2016 Feb 9;
Authors: Kassakian SZ, Yackel T, Deloughery T, Dorr D
BACKGROUND: Red blood cell transfusion is the most common procedure in hospitalized patients in the U.S. Growing evidence suggests that a sizeable percentage of these transfusions are inappropriate, putting patients at significant risk and increasing costs to the healthcare system.
METHODS: We performed a retrospective quasi-experimental study from November 2008 until November 2014 in a 576 bed tertiary care hospital. The intervention consisted of an interruptive clinical decision support alert shown to a provider when a red blood cell transfusion was ordered in a patient whose most recent hematocrit was ≥ 21%. We used interrupted time series analysis to determine whether our primary outcome of interest, rate of red blood cell transfusion in patients with hematocrit ≥21% per 100 patient (pt.) days, was reduced by the implementation of the clinical decision support tool. The rate of platelet transfusions was used as a non-equivalent dependent control variable.
RESULTS: A total of 143,000 hospital admissions were included in our analysis. Red blood cell transfusions decreased from 9.4 to 7.8 per 100 patient-days after the clinical decision support intervention was implemented. Interrupted time series analysis showed significant decline of 0.05 (95% CI 0.03-0.07; p<0.001) units red blood cell transfused per 100 pt. days per month was already underway in the pre-intervention period. This trend accelerated to 0.1 (95% CI 0.09 - 0.12; p<0.001) units red blood cell transfused per 100 pt. days per month following the implementation of the clinical decision support tool. There was no statistical change in the rate of platelet transfusion resulting from the intervention.
CONCLUSIONS: The implementation of an evidence-based clinical decision support tool was associated with a significant decline in the overuse use of red blood cell transfusion. We believe this intervention could be easily replicated in other hospitals using commercial EHRs and a similar reduction in overuse of red blood cell transfusions achieved.
PMID: 26873112 [PubMed - as supplied by publisher]