title: Trends in RBC ordering and use after implementing adaptive alerts in the electronic computerized physician order entry system.
abstract: OBJECTIVE
  To reduce unnecessary RBC transfusions, the computerized physician order entry (CPOE) system was programmed to require prescribers to select an indication for transfusion. An alert appeared if the patient's hemoglobin (Hb) level was above the threshold determined by the selected indication (adaptive alerts).
  
  
  METHODS
  Data on RBC orders from the 4 months before the adaptive alerts were implemented were compared with the 10 months after implementation.
  
  
  RESULTS
  Significantly fewer alerts were generated after the implementation, and the rate at which the alerts were heeded also increased. There was a trend toward fewer RBC units transfused after adaptive alert implementation. A large number of RBCs were ordered using a nonspecific transfusion indication, although many of these patients had antecedent Hb values close to the threshold.
  
  
  CONCLUSIONS
  Electronically generated alerts can reduce but are insufficient to eliminate non-evidence-based transfusions. Analysis of the alerts suggests areas for CPOE improvement.
authors.affiliation: The Institute for Transfusion Medicine, 3636 Blvd of the Allies, Pittsburgh, PA 15213; myazer@itxm.org.
authors.forename: Brian
authors.initials: B
authors.lastname: McWilliams
authors.forename: Darrell J
authors.initials: DJ
authors.lastname: Triulzi
authors.forename: Jonathan H
authors.initials: JH
authors.lastname: Waters
authors.forename: Louis H
authors.initials: LH
authors.lastname: Alarcon
authors.forename: Vivek
authors.initials: V
authors.lastname: Reddy
authors.forename: Mark H
authors.initials: MH
authors.lastname: Yazer
mesh_terms: D001803:Blood Transfusion / Q000706:statistics & numerical data; D020000:Decision Support Systems, Clinical / Q000706:statistics & numerical data; D017707:Erythrocyte Transfusion / Q000706:statistics & numerical data*; D006454:Hemoglobins / Q000032:analysis; D006801:Humans; D050316:Medical Order Entry Systems / Q000706:statistics & numerical data
chemical_list: D006454:Hemoglobins
keywords: Alert; Computerized order entry; Guidelines; Patient blood management; Red blood cell; Transfusion