title: Improving red blood cell orders, utilization, and management with point-of-care clinical decision support.
abstract: BACKGROUND
  The computerized order for red blood cell (RBC) transfusion within our electronic health record was redesigned with integrated clinical decision support (CDS) to reinforce our restrictive transfusion policy. These changes encouraged 1-unit (1U) RBC orders, clarified hemoglobin (Hb) transfusion triggers, and discouraged unnecessary orders. This study assessed whether these changes resulted in durable effects on provider practices.
  
  
  METHODS
  The study compared three 1-year subperiods from August 2011 to August 2014, with each year corresponding to a historical control period, preintervention and postintervention years. This study analyzed ratios of 1U versus 2-unit (2U) orders and the absolute rate of RBC orders, units charged, Hb transfusion triggers, repeat transfusion orders, and selected clinical indications both institution-wide and across several subpopulations.
  
  
  RESULTS
  Our institution-wide ratio of 1U versus 2U orders increased from 0.50 to 1.20 (p < 0.0001) in the pre- to postintervention subperiods, respectively. The number of units charged per day decreased from 15.68 to 13.53 (p < 0.001), while rates of initial and repeat orders remained stable. Proportion of clinical indications used and mean Hb triggers demonstrated generally positive results. The changes observed between the pre- and postintervention years were far greater than changes between historical control versus preintervention years, reinforcing attribution of results to computerized physician order entry changes.
  
  
  CONCLUSIONS
  Use of computerized orders and CDS encouraged a restrictive transfusion policy, which was highly successful in changing provider practices. We also succeeded in decreasing mean Hb triggers and overall utilization of RBCs. These findings persisted across many subpopulations.
authors: Clinical Informatics, Hennepin County Medical Center; Occupational and Environmental Medicine, HealthPartners/University of Minnesota Occupational and Environmental Medicine Residency; and the Division of Environmental Health Sciences, University of Minnesota School of Public Health, Minneapolis, Minnesota.
authors: Zeke J
authors: ZJ
authors: McKinney
authors: Transfusion Service, Hennepin County Medical Center, Minneapolis, Minnesota.
authors: Jessica M
authors: JM
authors: Peters
authors: Transfusion Service, Hennepin County Medical Center, Minneapolis, Minnesota.|Medical Support & Research, Innovative Blood Resources, St Paul, Minnesota.
authors: Jed B
authors: JB
authors: Gorlin
authors: Transfusion Service, Hennepin County Medical Center, Minneapolis, Minnesota.|Medical Support & Research, Innovative Blood Resources, St Paul, Minnesota.
authors: Elizabeth H
authors: EH
authors: Perry
mesh_terms: D020000:Decision Support Systems, Clinical / Q000592:standards*; D017707:Erythrocyte Transfusion; D004912:Erythrocytes; D005260:Female; D006801:Humans; D008297:Male; D050316:Medical Order Entry Systems / Q000592:standards*; D019095:Point-of-Care Systems / Q000592:standards*; D012189:Retrospective Studies; D014193:Trauma Centers