title: Efficacy of education followed by computerized provider order entry with clinician decision support to reduce red blood cell utilization.
abstract: BACKGROUND
  Two necessary components of a patient blood management program are education regarding evidence-based transfusion guidelines and computerized provider order entry (CPOE) with clinician decision support (CDS). This study examines changes in red blood cell (RBC) utilization associated with each of these two interventions.
  
  
  METHODS
  We reviewed 5 years of blood utilization data (2009-2013) for 70,118 surgical patients from 10 different specialty services at a tertiary care academic medical center. Three distinct periods were compared: 1) before blood management, 2) education alone, and 3) education plus CPOE. Changes in RBC unit utilization were assessed over the three periods stratified by surgical service. Cost savings were estimated based on RBC acquisition costs.
  
  
  RESULTS
  For all surgical services combined, RBC utilization decreased by 16.4% with education alone (p = 0.001) and then changed very little (2.5% increase) after subsequent addition of CPOE (p = 0.64). When we compared the period of education plus CPOE to the pre-blood management period, the overall decrease was 14.3% (p = 0.008; 2102 fewer RBC units/year, or a cost avoidance of $462,440/year). Services with the highest massive transfusion rates (≥10 RBC units) exhibited the least reduction in RBC utilization.
  
  
  CONCLUSIONS
  Adding CPOE with CDS after a successful education effort to promote evidence-based transfusion practice did not further reduce RBC utilization. These findings suggest that education is an important and effective component of a patient blood management program and that CPOE algorithms may serve to maintain compliance with evidence-based transfusion guidelines.
authors: Department of Anesthesiology/Critical Care Medicine, Baltimore, Maryland.
authors: Gabriel S
authors: GS
authors: Zuckerberg
authors: Department of Anesthesiology/Critical Care Medicine, Baltimore, Maryland.
authors: Andrew V
authors: AV
authors: Scott
authors: Department of Anesthesiology/Critical Care Medicine, Baltimore, Maryland.
authors: Jack O
authors: JO
authors: Wasey
authors: Department of Surgery, Baltimore, Maryland.
authors: Elizabeth C
authors: EC
authors: Wick
authors: Department of Surgery, Baltimore, Maryland.
authors: Timothy M
authors: TM
authors: Pawlik
authors: Department of Pathology (Transfusion Medicine), Baltimore, Maryland.
authors: Paul M
authors: PM
authors: Ness
authors: Department of Surgery, Baltimore, Maryland.
authors: Nishant D
authors: ND
authors: Patel
authors: Department of Medicine (Hematology), Oncology & Institute for Cellular Engineering, Johns Hopkins Medical Institutions, Baltimore, Maryland.
authors: Linda M S
authors: LM
authors: Resar
authors: Department of Anesthesiology/Critical Care Medicine, Baltimore, Maryland.
authors: Steven M
authors: SM
authors: Frank
mesh_terms: D003365:Costs and Cost Analysis; D003658:Decision Making, Computer-Assisted; D004502:Education, Medical, Continuing / Q000191:economics / Q000379:methods*; D017707:Erythrocyte Transfusion; D005260:Female; D006801:Humans; D008297:Male; D050316:Medical Order Entry Systems; D017410:Practice Guidelines as Topic; D012189:Retrospective Studies; D012984:Software