title: Evidence-based red cell transfusion in the critically ill: quality improvement using computerized physician order entry.
abstract: OBJECTIVE
  The implementation of evidence-based practice poses a significant challenge in the intensive care unit. In this quality improvement intervention we assessed the effect of an institutional protocol and computerized decision support for red cell transfusion in the critically ill.
  
  
  METHODS
  We compared processes of care and outcomes during the two 3-month periods before and after the introduction of a multidisciplinary quality improvement intervention.
  
  
  METHODS
  Multidisciplinary intensive care units--medical, surgical, and mixed--in a tertiary academic center.
  
  
  METHODS
  Consecutive critically ill patients with anemia (hemoglobin of <10 g/dL).
  
  
  METHODS
  Using the computerized provider order entry, we developed an evidence-based decision algorithm for red cell transfusion in adult intensive care units.
  
  
  RESULTS
  We collected information on demographics, diagnosis, severity of illness, transfusion complications, and laboratory values. The main outcome measures were number of transfusions, proportion of patients who were transfused outside evidence-based indications, transfusion complications, and adjusted hospital mortality. The mean number of red cell transfusions per intensive care unit admission decreased from 1.08 +/- 2.3 units before to 0.86 +/- 2.3 units after the protocol (p<.001). We observed a marked decrease in the percentage of patients receiving inappropriate transfusions (17.7% vs. 4.5%, p< .001). The rate of transfusion complications was also lower in the period after the protocol (6.1% vs. 2.7%, p = .015). In the multivariate analysis, protocol introduction was associated with decreased likelihood of red cell transfusion (odds ratio, 0.43; 95% confidence interval, 0.30 to 0.62). Adjusted hospital mortality did not differ before and after protocol implementation (odds ratio, 1.12; 95% confidence interval, 0.69 to 1.8).
  
  
  CONCLUSIONS
  The implementation of an institutional protocol and decision support through a computerized provider order entry effectively decreased inappropriate red cell transfusions.
authors.affiliation: Family Medicine Residency, Mercy Medical Center-North Iowa, Mason City, IA, USA.
authors.forename: Rimki
authors.initials: R
authors.lastname: Rana
authors.forename: Bekele
authors.initials: B
authors.lastname: Afessa
authors.forename: Mark T
authors.initials: MT
authors.lastname: Keegan
authors.forename: Francis X
authors.initials: FX
authors.lastname: Whalen
authors.forename: Gregory A
authors.initials: GA
authors.lastname: Nuttall
authors.forename: Laura K
authors.initials: LK
authors.lastname: Evenson
authors.forename: Steve G
authors.initials: SG
authors.lastname: Peters
authors.forename: Jeffrey L
authors.initials: JL
authors.lastname: Winters
authors.forename: Rolf D
authors.initials: RD
authors.lastname: Hubmayr
authors.forename: S Breanndan
authors.initials: SB
authors.lastname: Moore
authors.forename: Ognjen
authors.initials: O
authors.lastname: Gajic
mesh_terms: D000465:Algorithms; D000740:Anemia / Q000628:therapy; D016638:Critical Illness / Q000628:therapy*; D003658:Decision Making, Computer-Assisted; D003661:Decision Support Techniques; D017707:Erythrocyte Transfusion / Q000592:standards*; D019317:Evidence-Based Medicine; D006801:Humans; D007362:Intensive Care Units; D010348:Patient Care Team; D011787:Quality of Health Care / Q000592:standards