Saag Harry S, Lajam Claudette M, Jones Simon, Lakomkin Nikita, Bosco Joseph A, Wallack Rebecca, Frangos Spiros G, Sinha Prashant, Adler Nicole, Ursomanno Patti, Horwitz Leora I, Volpicelli Frank M
Division of General Internal Medicine and Clinical Innovation, Department of Medicine, NYU School of Medicine, New York, New York.
Department of Orthopedic Surgery, NYU Langone Medical Center Hospital for Joint Diseases, New York, New York.
Transfusion. 2017 Apr;57(4):959-964. doi: 10.1111/trf.13967. Epub 2016 Dec 30.
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.
教育和计算机化干预已被证明可降低红细胞（RBC）输注率，但围绕实现自由输血持续减少所需的最佳策略仍存在争议。
本研究的目的是评估临床医生决策支持（CDS）以及针对性教育对四个高使用量服务线的自由红细胞利用情况的影响，并与学术医疗中心的对照服务线的无教育情况进行比较。通过回顾性病历审查获得了2014年4月至2015年12月所有输血医嘱时的临床数据以及相关血红蛋白水平。主要结局是自由红细胞输血医嘱率的变化（定义为血红蛋白水平>7.0 g/dL时的任何红细胞输血）。次要结局包括每年预计减少的输血量、因这些变化导致的相关成本降低以及住院时间（LOS）和死亡指数。在该举措实施前的12个月和干预后的9个月期间对这些指标进行了比较。
整个机构的自由红细胞利用率从每100例出院患者13.4单位降至10.0单位（p = 0.002），预计12个月节省720,360美元。干预后时期的平均住院时间和死亡指数无显著差异。
针对性教育与在医嘱录入时纳入CDS相结合，可显著降低自由红细胞利用的发生率，且不会对住院患者护理产生不利影响，而仅接受CDS的对照服务线的输血习惯没有变化。
