Sardar Muhammad, Azharuddin Muhammad, Subedi Ananta, Ghatage Prateek, Du Doantarang, Szallasi Arpad
Department of Internal Medicine, Monmouth Medical Center, 300 2nd Ave, Long Branch, NJ 07740, USA.
Department of Pathology, Monmouth Medical Center, 300 2nd Ave, Long Branch, NJ 07740, USA.
Med Sci (Basel). 2018 Aug 22;6(3):67. doi: 10.3390/medsci6030067.
There is good evidence that 50% or more of red blood cell (RBC) transfusions are unnecessary. To curtail inappropriate RBC transfusions at our hospital, real-time clinical decision support was implemented in our electronic medical record (EMR) that alerts clinicians to the patient's most recent pretransfusion hemoglobin value upon order entry and provides Best Practice Advisory. This is a soft pop-up alert which is activated when the hemoglobin exceeds 7 g/dL. The ordering clinician can either honor (by cancelling the order) or override the alert. We studied the impact of the alert on blood utilization during a 3-month period (November 2016 to January 2017). For patients who were transfused despite the alert, a retrospective review of the medical chart was performed to determine whether or not the transfusion was clinically indicated. During the study period, 178 of the 895 RBC transfusion orders (20%) triggered the alert. After excluding duplicates, 144 orders were included in our analysis. Most of these orders (124/144, 86%) were carried out despite the alert. According to our chart review, 48% of the alert transfusions could be considered inappropriate, with hemodynamically stable, asymptomatic anemia being the leading indication. Of clinical services, orthopedic surgery had the highest rate of overriding the alert with no clinical justification (70%). The number of RBC transfusions dropped from 313.5 units per month (preintervention period) to 293.2 units per month (postintervention period)-a 6.5% decrease. Real-time clinical decision support may reduce the number of inappropriate RBC transfusions in a community hospital setting, though in our study, the decrease in blood utilization (6.5%) did not reach statistical significance.
有充分证据表明，50% 或更多的红细胞（RBC）输血是不必要的。为了在我院减少不适当的RBC输血，我们在电子病历（EMR）中实施了实时临床决策支持，在下达输血医嘱时提醒临床医生患者最近一次输血前的血红蛋白值，并提供最佳实践建议。这是一个软弹出式警报，当血红蛋白超过7 g/dL时触发。下达医嘱的临床医生可以选择遵守（通过取消医嘱）或忽略该警报。我们研究了该警报在3个月期间（2016年11月至2017年1月）对血液使用的影响。对于尽管收到警报仍接受输血的患者，我们对病历进行了回顾性审查，以确定输血是否具有临床指征。在研究期间，895份RBC输血医嘱中有178份（20%）触发了警报。排除重复医嘱后，144份医嘱纳入我们的分析。尽管收到警报，这些医嘱中的大多数（124/144，86%）仍被执行。根据我们的病历审查，48% 的警报输血可被视为不适当，血流动力学稳定、无症状贫血是主要指征。在临床科室中，骨科手术在无临床理由的情况下忽略警报的比例最高（70%）。RBC输血量从每月313.5单位（干预前期）降至每月293.2单位（干预后期），下降了6.5%。实时临床决策支持可能会减少社区医院环境中不适当的RBC输血数量，不过在我们的研究中，血液使用量的下降（6.5%）未达到统计学显著性。
