Harry S Saag1, Claudette M Lajam2, Simon Jones3, Nikita Lakomkin2, Joseph A Bosco2, Rebecca Wallack4, Spiros G Frangos5, Prashant Sinha5, Nicole Adler1, Patti Ursomanno4, Leora I Horwitz1,3, Frank M Volpicelli1. 1. Division of General Internal Medicine and Clinical Innovation, Department of Medicine, NYU School of Medicine, New York, New York. 2. Department of Orthopedic Surgery, NYU Langone Medical Center Hospital for Joint Diseases, New York, New York. 3. Division of Healthcare Delivery Science, Department of Population Health, NYU School of Medicine, New York, New York. 4. Department of Strategy and Finance, NYU Langone Medical Center, New York, New York. 5. Department of Surgery, NYU School of Medicine, New York, New York.
Abstract
BACKGROUND: 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. STUDY DESIGN AND METHODS: 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. RESULTS: 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. CONCLUSION: 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.
BACKGROUND: 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. STUDY DESIGN AND METHODS: 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. RESULTS: 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. CONCLUSION: 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: Steven C Chatfield; Frank M Volpicelli; Nicole M Adler; Kunhee Lucy Kim; Simon A Jones; Fritz Francois; Paresh C Shah; Robert A Press; Leora I Horwitz Journal: BMJ Qual Saf Date: 2019-03-15 Impact factor: 7.035
Authors: Andrea Saporito; Davide La Regina; Axel Hofmann; Lorenzo Ruinelli; Alessandro Merler; Francesco Mongelli; Kevin M Trentino; Paolo Ferrari Journal: Front Med (Lausanne) Date: 2022-08-30