The next chapter in patient blood management: real-time clinical decision support.
OBJECTIVE
Blood transfusion was identified by the American Medical Association as one of the top five most frequently overused therapies. Utilization review has been required by accreditation agencies, but retrospective review has been ineffective due to labor-intense resources applied to only a sampling of transfusion events. Electronic medical records have allowed clinical decision support (CDS) to occur via a best practices alert at the critical decision point concurrently with physician order entry.


METHODS
We review emerging strategies for improving blood utilization.


RESULTS
Implementation of CDS at our institution decreased the percentage of transfusions in patients with a hemoglobin level of more than 8 g/dL from 60% to less than 30%. Annual RBC transfusions were reduced by 24%, despite concurrent increases in patient discharge volumes and case mix complexity. This resulted in acquisition costs savings (direct blood product purchase costs) of $6.4 million over 4 years.


CONCLUSIONS
We have been able to significantly reduce inappropriate blood transfusions and related costs through an educational initiative coupled with real-time CDS. In deriving increased value out of health care, CDS can be applied to a number of overuse measures in laboratory testing, radiology, and therapy such as antibiotics, as outlined by the American Board of Internal Medicine's Choosing Wisely campaign.
From the Departments of Pathology and Medicine, Stanford University, Stanford, CA. ltgoodno@stanford.edu.
Lawrence Tim
LT
Goodnough
From the Departments of Pathology and.
Neil
N
Shah
D001803:Blood Transfusion / Q000706:statistics & numerical data*; D020000:Decision Support Systems, Clinical; D006801:Humans; D014600:Utilization Review
Best practice alert; Blood transfusion; Blood utilization; Clinical decision support; Electronic medical records; Physician order entry