利用实时临床决策支持优化住院患者的血液利用。
Optimizing Inpatient Blood Utilization Using Real-Time Clinical Decision Support.
机构信息
Department of Pathology, Keck School of Medicine, University of Southern California, Los Angeles, California, United States.
Health Information Technology, University of California, Los Angeles, California, United States.
出版信息
Appl Clin Inform. 2021 Jan;12(1):49-56. doi: 10.1055/s-0040-1721779. Epub 2021 Jan 27.
BACKGROUND
Red blood cell (RBC) transfusion is a common medical procedure. While it offers clinical benefits for many, hemodynamically stable patients are often subjected to unwarranted transfusions, with the potential to lead to adverse consequences. We created a real-time clinical decision support (CDS) tool in the electronic health record system to address this problem and optimize transfusion practice as part of an institutional multidisciplinary, team-based patient blood management program.
METHODS
The real-time CDS tool incorporated the transfusion guidelines published by the AABB. The tool was deployed as a dynamic order set within the computerized provider order entry interface. Prior to implementation, extensive education and outreach to increase provider engagement were provided. The CDS tool was launched in September 2015.
RESULTS
The percentage of guideline-indicated RBC transfusions increased from a baseline of 43.6 to 54.2% while the percentage of multiunit (≥ 2 units) RBC transfusions decreased from 31.3 to 22.7% between September 2014 and July 2019. The estimated minimum cost saving over the entire study period was $36,519.36.
CONCLUSION
Our intervention increased guideline-indicated transfusions by 10.6% and reduced multiunit transfusions by 8.6%. The adoption of a dynamic order set for the CDS tool, as opposed to an interruptive alert that displays static alert messages, allowed for more customized and tighter control of RBC orders, leading to a sustained improvement in our transfusion practice.
背景
红细胞（RBC）输血是一种常见的医疗程序。虽然它为许多患者带来了临床益处，但血液动力学稳定的患者经常接受不必要的输血，这可能导致不良后果。我们在电子健康记录系统中创建了一个实时临床决策支持（CDS）工具，以解决这个问题，并作为机构多学科、基于团队的患者血液管理计划的一部分优化输血实践。
方法
实时 CDS 工具纳入了 AABB 发布的输血指南。该工具作为计算机化医嘱输入界面中的动态医嘱集部署。在实施之前，提供了广泛的教育和外联服务，以提高提供者的参与度。该 CDS 工具于 2015 年 9 月推出。
结果
在 2014 年 9 月至 2019 年 7 月期间，指南指示的 RBC 输血百分比从 43.6%增加到 54.2%，而多单位（≥2 单位）RBC 输血百分比从 31.3%减少到 22.7%。整个研究期间估计最低节省成本为 36519.36 美元。
结论
我们的干预措施使指南指示的输血增加了 10.6%，多单位输血减少了 8.6%。采用动态医嘱集而不是显示静态警报消息的中断性警报来实现 CDS 工具，可以更定制化和更严格地控制 RBC 医嘱，从而持续改善我们的输血实践。
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