The appropriateness and physician compliance of platelet usage by a computerized transfusion decision support system in a medical center.
BACKGROUND
The prescribing of inappropriate platelet (PLT) transfusions is always a significant problem. A computerized transfusion decision support system (CTDSS) has been used in Kaohsiung Medical University Hospital since September 2004. In this study, the physician compliance and appropriateness of PLT usage after using the CTDSS were investigated.


METHODS
A total of 5887 PLT transfusion episodes between January and December 2008 were reviewed including the demographic data and the "true reason" for each transfusion practice. The pre- and posttransfusion PLT counts were retrieved. The physician compliance, the appropriateness of PLT usage, and the PLT increments after transfusion were investigated.


RESULTS
Physician compliance was 85.4%, and the appropriateness of PLT usage was 69.6%. The most commonly chosen indication from the CTDSS was "prophylactic use, PLT count ≤20×10(9) /L." The highest inappropriate order rate was from the emergency department. More than half of the inappropriate episodes were from the surgery unit. The inappropriate rates were significant in terms of both different order sources and functional units (p<0.0001). The posttransfusion PLT counts increased in two-thirds of the episodes, and most of them were with the pretransfusion PLT counts of less than 50×10(9) /L.


CONCLUSIONS
In Taiwan, the PLT concentration is too low-priced and this might cause the overuse of blood components. Under the global budget of National Health Insurance, preventing the overuse of blood components might serve as one of the mechanism to improve medical quality. The CTDSS should be more powerful and effective to intervene in the appropriateness of transfusion practice.
Lin
Yi-Ching
YC
Department of Laboratory Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung City, Taiwan.
Chang
Chao-Sung
CS
Yeh
Chi-Jung
CJ
Wu
Yung-Chao
YC
D000046:Academic Medical Centers; D000465:Algorithms; D002983:Clinical Competence / Q000706:statistics & numerical data; D003198:Computer Simulation / Q000706:statistics & numerical data; D003661:Decision Support Techniques; D005260:Female; D019983:Guideline Adherence / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D010820:Physicians / Q000592:standards / Q000706:statistics & numerical data; D017713:Platelet Transfusion / Q000706:statistics & numerical data*; D015397:Program Evaluation; D012189:Retrospective Studies