Effects of a Platelet Transfusion Best Practices Alert

Stanford University

Status: Completed

Conditions: Thrombocytopenia

Treatments: Other: Computer electronic health record alert (Best Practice Alert - BPA)

Study type: Interventional

Funder types: Other

Identifiers

NCT04155775

IRB-47797

Details and patient eligibility

About

This study is to determine the effectiveness of a computerized clinical decision support tool (Best Practice Alert - BPA) in reducing unnecessary platelet transfusions based on guidelines published by national transfusion societies such as the AABB (formerly American Association of Blood Banks).

Full description

A computerized alert will be deployed through the electronic health record. The alert will trigger when a provider orders platelet transfusion above a threshold supported by current guidelines. The alert will provide information on current evidence and give the provider the option to cancel the order or proceed. The alert will not be triggered in procedural areas such as the operating room or as part of any emergency orders to prevent any delays to urgent patient care.

The proposed project will evaluate this alert by randomizing its implementation by patient chart. The investigators will observe the prevalence of this alert and its impact on ordering practices for the next 3 months. For patient charts randomized not to receive the intervention, the providers will not receive any alerts, but the analytics tool will record if the alert would have been triggered and the pertinent clinical information. After a period of three months, the investigators will review patient and provider information through analytics tools, assessing differences in platelet usage between the patients whose charts showed the alerts vs. those (control) patient charts not showing alerts.

Enrollment: 446 patients

Sex: All

Volunteers: No Healthy Volunteers

Inclusion criteria

• Recent platelet count >50k/uL
• Platelet transfusion ordered

Exclusion criteria

• Neurosurgery
• Procedure area (OR, catheterization lab, interventional radiology suite)
• Documented history of antiplatelet agent

Trial design

Primary purpose: Other

Allocation: Randomized

Interventional model: Parallel Assignment

Masking: None (Open label)

---

446 participants in 2 patient groups

Best Practice Alert

Experimental group

Description:

Platelet transfusion orders for patients with a recent platelet count exceeding 50,000 per microliter (50k/uL) will trigger an alert in the electronic health record that displays current guidelines for platelet transfusion. The alert will allow providers to bypass the recommendation and continue with platelet ordering by selecting a clinical acknowledgement / exception to recommendation.Exclusions will be built into the alert to avoid triggering in operative or procedural settings, for neurosurgery providers, or patients on anti-platelet medications.

Treatment:

Other: Computer electronic health record alert (Best Practice Alert - BPA)

No Best Practice Alert

No Intervention group

Description:

For this group, no visible best practice alert will activate in the electronic health record for platelet transfusion orders and recent counts above 50k/uL.