Hibbs S P, Noel S, Miles D, Staves J, Murphy M F
Oxford University Clinical Academic Graduate School, University of Oxford; Blood Safety and Conservation Team, Oxford University Hospitals (OUH) NHS Trust.
Transfus Med. 2014 Oct;24(5):274-9. doi: 10.1111/tme.12149. Epub 2014 Sep 3.
To assess the impact on transfusion practice of a two-stage electronic intervention: the introduction of a decision support system (DSS) followed by the addition of electronic remote blood issue (ERBI).
With increasing evidence to show the benefit of restrictive transfusion policies, it is important to ascertain which interventions can increase clinician compliance with their implementation. A DSS provides patient-specific recommendations to clinicians. ERBI reduces delays in acquiring blood and may alter the transfusion behaviour of clinicians.
All electronically requested blood transfusions administered outside of surgical theatres or recovery were identified in an orthopaedic hospital. These were divided into three time periods corresponding to pre-intervention, the successive introduction of DSS alone and DSS with ERBI. Pre- and post-transfusion haemoglobin (Hb) concentration levels, and the number of units ordered and transfused were recorded.
A total of 204 transfusions for 92 patients were assessed; 38 of 85 (45%) transfusions in the first time period were compliant. This did not significantly change after introduction of the DSS, but with DSS and ERBI together significantly increased to 39 of 60 (65%) (P < 0·05). Mean pre-transfusion Hb reduced from 8·24 g dl(-1) in the first time period to 7·67 g dl(-1) in the third (P < 0·0001). There was no significant change in overall blood usage, although ERBI significantly reduced the amount of unused blood orders from 70 to 25%.
Electronic DSS was not sufficient to change practice in the form implemented in this study. ERBI can contribute to significant improvements in blood usage as well as the efficiency of blood provision.
评估两阶段电子干预措施对输血实践的影响：引入决策支持系统（DSS），随后增加电子远程血液发放（ERBI）。
越来越多的证据表明限制性输血政策的益处，确定哪些干预措施能够提高临床医生对其实施的依从性很重要。决策支持系统为临床医生提供针对患者的建议。电子远程血液发放减少了获取血液的延迟，并可能改变临床医生的输血行为。
在一家骨科医院中识别出所有在手术室或恢复室以外通过电子方式申请的输血。这些输血被分为三个时间段，分别对应干预前、单独引入决策支持系统以及引入决策支持系统和电子远程血液发放。记录输血前后的血红蛋白（Hb）浓度水平以及订购和输注的单位数量。
共评估了92例患者的204次输血；第一个时间段85次输血中有38次（45%）符合要求。引入决策支持系统后这一比例没有显著变化，但决策支持系统和电子远程血液发放同时使用时，符合要求的比例显著提高至60次中的39次（65%）（P<0.05）。输血前平均血红蛋白水平从第一个时间段的8.24 g/dl降至第三个时间段的7.67 g/dl（P<0.0001）。总体血液使用量没有显著变化，尽管电子远程血液发放显著减少了未使用血液订单的数量，从70%降至25%。
电子决策支持系统不足以改变本研究中所实施形式的实践。电子远程血液发放有助于显著改善血液使用情况以及血液供应效率。
