Blood Transfusion Reduction - QI Project

University of Colorado Denver (CU Denver)

Status: Completed

Conditions: Blood Transfusion

Treatments: Behavioral: General improvement; Behavioral: Interruptive alert; Behavioral: In-line help text

Study type: Interventional

Funder types: Other

Identifiers

NCT04823273

19-0918

Details and patient eligibility

About

Blood Banks of large medical centers have large annual budgets, typically millions of dollars. Blood product wastage results in not only in a loss of the product's cost, but also of the fees involved in transporting, handling, and administering these products. Optimal utilization of blood products requires a balance between maximizing patient clinical outcomes while avoiding unnecessary costs and risks associated with transfusions. This project will specifically focus on packed red blood cell transfusions (pRBCs). There are clear guidelines for transfusing pRBCs however these guidelines are not always followed. pRBC transfusions outside of recommended guidelines is associated with increased risk of harm to patients.

Our aim is to improve adherence to guideline indicated pRBC transfusions for patient in the UCHealth system thereby decreasing inappropriate (non-guideline indicated) pRBC transfusions. We will conduct a QI project seeking to improve pRBC transfusion guideline adherence. This project will involve data review to establish baseline rates, multimodal interventions to improve adherence to pRBC transfusion guidelines including provider education, modifications to the electronic ordering interface, and changing blood back policies at participating institutions.

Enrollment: 1,640 patients

Sex: All

Volunteers: Accepts Healthy Volunteers

Inclusion criteria

• All physicians and nurses with access to order inpatient blood transfusions through a hospital-based EMR.
• All physicians and nurses ordering blood for individuals over the age of 18.

Exclusion criteria

• All physicians and nurses ordering blood transfusion ordering blood in the OR
• Blood ordered through massive transfusion protocol

Trial design

Primary purpose: Health Services Research

Allocation: Randomized

Interventional model: Parallel Assignment

Masking: Single Blind

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1,640 participants in 3 patient groups

General improvement

Experimental group

Description:

Using the expertise of the study personnel, electronic-health record system architects working for UCHealth, and incorporating feedback from the users who participated in the user-centered design sessions we made changes to the blood transfusion order-set as well as the "prepare" and "transfuse" orders. The intention of the changes to the interface are to be more intuitive for ordering clinicians.

Treatment:

Behavioral: General improvement

In-line help text

Experimental group

Description:

In addition to general improvement changes, subjects exposed to the in-line help text arm receive text detailing evidence-based transfusion recommendations that appear if the most recent hemoglobin level is above 7.0 g/dL. This text appears within the transfusion order but is non-interruptive as it does not require users to acknowledge the text nor does is require any additional keystrokes or clicks.

Treatment:

Behavioral: In-line help text

Interruptive alert

Experimental group

Description:

In addition to general improvement changes, subjects exposed to the interruptive alert arm receive text detailing evidence-based transfusion recommendations that appear if the most recent hemoglobin level is above 7.0 g/dL. In contrast to the in-line help text arm, this arm includes an interruptive alert that appears when the user selects the transfusion order. This alert offers users the option to remove the order which results in no-blood product ordered. Alternatively, users may continue to order blood and are asked to select the reason for proceeding with the intended order.

Treatment:

Behavioral: Interruptive alert