title: Implementation of a clinical decision support system improves compliance with restrictive transfusion policies in hematology patients.
abstract: BACKGROUND
  There is increasing evidence for restrictive red blood cell (RBC) transfusion but compliance with recommended transfusion triggers is variable. A clinical decision support system (CDSS) has been found to reduce unnecessary transfusion in some clinical settings when physicians are advised they are noncompliant with the current guidelines. The objective was to assess the impact of a CDSS for blood product ordering in patients with hematologic disease.
  
  
  METHODS
  All platelet (PLT) and RBC transfusions were identified in hematology patients in three periods: before (baseline), immediately after (CDSS1), and 7 months after implementation of CDSS for blood ordering (CDSS2). Compliance with the recommended transfusion triggers was monitored for all orders made by CDSS or non-CDSS methods during each period.
  
  
  RESULTS
  Ninety-seven patients with a variety of hematologic diagnoses received 502 RBC and 572 PLT transfusions during the three periods with no significant difference in 1) the mean number of transfusions per patient, 2) the proportion of patients transfused, 3) posttransfusion hemoglobin (Hb), and 4) pre- and posttransfusion PLT count, although mean pretransfusion Hb decreased. The proportion of noncompliant RBC and PLT transfusion requests improved from baseline to CDSS2 (69.0% to 43.4% p ≤ 0.005 for RBCs; and 41.9% to 31.2%, p = 0.16 for PLT) when all orders were compared, although this improvement was not significant at the 5% level for PLTs.
  
  
  CONCLUSIONS
  The introduction of CDSS for blood product ordering supported by education and physician feedback in the hematology setting had an immediate impact on improving compliance with guidelines for restrictive transfusion practice.
authors.affiliation: Oxford University Clinical Academic Graduate School.|NHS Blood & Transplant.
authors.forename: Caroline E
authors.initials: CE
authors.lastname: Butler
authors.affiliation: NHS Blood & Transplant.|Oxford University Hospitals (OUH) NHS Trust.
authors.forename: Simon
authors.initials: S
authors.lastname: Noel
authors.affiliation: Oxford University Clinical Academic Graduate School.|NHS Blood & Transplant.
authors.forename: Stephen P
authors.initials: SP
authors.lastname: Hibbs
authors.affiliation: Oxford University Hospitals (OUH) NHS Trust.
authors.forename: David
authors.initials: D
authors.lastname: Miles
authors.affiliation: Oxford University Hospitals (OUH) NHS Trust.
authors.forename: Julie
authors.initials: J
authors.lastname: Staves
authors.affiliation: Oxford University Hospitals (OUH) NHS Trust.
authors.forename: Payam
authors.initials: P
authors.lastname: Mohaghegh
authors.affiliation: Oxford University Hospitals (OUH) NHS Trust.
authors.forename: Paul
authors.initials: P
authors.lastname: Altmann
authors.affiliation: NHS Blood & Transplant.
authors.forename: Elinor
authors.initials: E
authors.lastname: Curnow
authors.affiliation: NHS Blood & Transplant.|Oxford University Hospitals (OUH) NHS Trust.|National Institute for Health Research (NIHR) Oxford Biomedical Research Centre, Oxford University Hospitals and the University of Oxford, Oxford, UK.
authors.forename: Michael F
authors.initials: MF
authors.lastname: Murphy
mesh_terms: D000328:Adult; D000368:Aged; D020000:Decision Support Systems, Clinical; D017707:Erythrocyte Transfusion / Q000592:standards / Q000706:statistics & numerical data*; D005260:Female; D019983:Guideline Adherence; D006402:Hematologic Diseases / Q000097:blood / Q000628:therapy*; D006454:Hemoglobins / Q000032:analysis; D006801:Humans; D057970:Inappropriate Prescribing / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D010976:Platelet Count; D017713:Platelet Transfusion / Q000592:standards / Q000706:statistics & numerical data*; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data; D055656:Prescriptions / Q000706:statistics & numerical data; D019564:Unnecessary Procedures
chemical_list: D006454:Hemoglobins