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

Background and Objectives Providing red blood cell (RBC) transfusion to paediatric patients with a haemoglobin (Hb) level of <7 g/dL is the current best practice, but it is often difficult to ensure appropriateness of RBC transfusion on a health system level. Electronic health record (EHR) clinic...

Full description

Saved in:

Bibliographic Details
Published in:	Vox sanguinis Vol. 118; no. 9; pp. 746 - 752
Main Authors:	Adkins, Brian D., Murfin, Roberta, Luu, Hung S., Noland, Daniel K.
Format:	Journal Article
Language:	English
Published:	Oxford, UK Blackwell Publishing Ltd 01-09-2023 S. Karger AG
Subjects:	Artificial intelligence Best practice best practice alert Blood transfusion Clinical decision making clinical decision support Decision support systems Electronic health records Electronic medical records Erythrocytes haemoglobin threshold Hemoglobin paediatric transfusion patient blood management Pediatrics System effectiveness Thresholds Transfusion paediatric transfusion erythrocytes patient blood management clinical decision support best practice alert haemoglobin threshold
Online Access:	Get full text
Tags:	Add Tag No Tags, Be the first to tag this record!

Description
Summary:	Background and Objectives Providing red blood cell (RBC) transfusion to paediatric patients with a haemoglobin (Hb) level of <7 g/dL is the current best practice, but it is often difficult to ensure appropriateness of RBC transfusion on a health system level. Electronic health record (EHR) clinical decision support systems have been shown to be effective in encouraging providers to transfuse at appropriate Hb thresholds. We present our experience with an interruptive best practice alert (BPA) at a paediatric healthcare system. Materials and Methods An interruptive BPA requiring physician response was implemented in our EHR (Epic Systems Corp., Verona, WI, USA) in 2018 based on Hb thresholds for inpatients. The threshold was initially <8 g/dL and later changed to <7 g/dL in 2019. We assessed total activations, number of RBC transfusions and hospital metrics through 2022 compared to the 2 years prior to implementation. Results The BPA activated 6956 times over 4 years, slightly less than 5/day, and the success rate, with no RBC transfusions within 24 h of order attempt, was 14.5% (1012/6956). There was a downward trend in the number of total RBC transfusions and RBC transfusions per admission after implementation, non‐significant (p = 0.41 and p = >0.99). The annual case mix index was similar over the years evaluated. The estimated cost savings based on acquisition costs for RBC units were 213,822 USD or about $51,891 per year. Conclusion BPA implementation led to sustained change in RBC transfusion towards best practice, and there were long‐term savings in RBC expenditure.
Bibliography:	Funding information The authors received no specific funding for this work. ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23
ISSN:	0042-9007 1423-0410 1423-0410
DOI:	10.1111/vox.13497