title: Reducing liberal red blood cell transfusions at an academic medical center.
abstract: Educational and computerized interventions have been shown to reduce red blood cell (RBC) transfusion rates, yet controversy remains surrounding the optimal strategy needed to achieve sustained reductions in liberal transfusions.
  
  
  
  The purpose of this study was to assess the impact of clinician decision support (CDS) along with targeted education on liberal RBC utilization to four high-utilizing service lines compared with no education to control service lines across an academic medical center. Clinical data along with associated hemoglobin levels at the time of all transfusion orders between April 2014 and December 2015 were obtained via retrospective chart review. The primary outcome was the change in the rate of liberal RBC transfusion orders (defined as any RBC transfusion when the hemoglobin level is >7.0 g/dL). Secondary outcomes included the annual projected reduction in the number of transfusions and the associated decrease in cost due to these changes as well as length of stay (LOS) and death index. These measures were compared between the 12 months prior to the initiative and the 9-month postintervention period.
  
  
  
  Liberal RBC utilization decreased from 13.4 to 10.0 units per 100 patient discharges (p = 0.002) across the institution, resulting in a projected 12-month savings of $720,360. The mean LOS and the death index did not differ significantly in the postintervention period.
  
  
  
  Targeted education combined with the incorporation of CDS at the time of order entry resulted in significant reductions in the incidence of liberal RBC utilization without adversely impacting inpatient care, whereas control service lines exposed only to CDS had no change in transfusion habits.
authors.affiliation: Division of General Internal Medicine and Clinical Innovation, Department of Medicine, NYU School of Medicine, New York, New York.
authors.forename: Harry S
authors.initials: HS
authors.lastname: Saag
authors.affiliation: Department of Orthopedic Surgery, NYU Langone Medical Center Hospital for Joint Diseases, New York, New York.
authors.forename: Claudette M
authors.initials: CM
authors.lastname: Lajam
authors.affiliation: Division of Healthcare Delivery Science, Department of Population Health, NYU School of Medicine, New York, New York.
authors.forename: Simon
authors.initials: S
authors.lastname: Jones
authors.affiliation: Department of Orthopedic Surgery, NYU Langone Medical Center Hospital for Joint Diseases, New York, New York.
authors.forename: Nikita
authors.initials: N
authors.lastname: Lakomkin
authors.affiliation: Department of Orthopedic Surgery, NYU Langone Medical Center Hospital for Joint Diseases, New York, New York.
authors.forename: Joseph A
authors.initials: JA
authors.lastname: Bosco
authors.affiliation: Department of Strategy and Finance, NYU Langone Medical Center, New York, New York.
authors.forename: Rebecca
authors.initials: R
authors.lastname: Wallack
authors.affiliation: Department of Surgery, NYU School of Medicine, New York, New York.
authors.forename: Spiros G
authors.initials: SG
authors.lastname: Frangos
authors.affiliation: Department of Surgery, NYU School of Medicine, New York, New York.
authors.forename: Prashant
authors.initials: P
authors.lastname: Sinha
authors.affiliation: Division of General Internal Medicine and Clinical Innovation, Department of Medicine, NYU School of Medicine, New York, New York.
authors.forename: Nicole
authors.initials: N
authors.lastname: Adler
authors.affiliation: Department of Strategy and Finance, NYU Langone Medical Center, New York, New York.
authors.forename: Patti
authors.initials: P
authors.lastname: Ursomanno
authors.affiliation: Division of General Internal Medicine and Clinical Innovation, Department of Medicine, NYU School of Medicine, New York, New York.|Division of Healthcare Delivery Science, Department of Population Health, NYU School of Medicine, New York, New York.
authors.forename: Leora I
authors.initials: LI
authors.lastname: Horwitz
authors.affiliation: Division of General Internal Medicine and Clinical Innovation, Department of Medicine, NYU School of Medicine, New York, New York.
authors.forename: Frank M
authors.initials: FM
authors.lastname: Volpicelli
mesh_terms: D003657:Decision Making; D017707:Erythrocyte Transfusion; D005260:Female; D006454:Hemoglobins / Q000378:metabolism*; D017052:Hospital Mortality; D006784:Hospitals, Teaching; D006801:Humans; D007902:Length of Stay; D008297:Male
chemical_list: D006454:Hemoglobins