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A3135
October 13, 2014
8:00 AM - 10:00 AM
Room Hall B1-Area A
Efficacy of Education Followed by Computerized Provider Order Entry (CPOE) with Clinician Decision Support (CDS) to Reduce RBC Utilization in a Tertiary Care Academic Medical Center
Steven M. Frank, M.D., Gabe S. Zuckerberg, B.S., Nishant D. Patel, M.D., Timothy M. Pawlik, M.D., Paul M. Ness, M.D., Linda M. Resar, M.D.
The Johns Hopkins Medical Institutions, Baltimore, Maryland, United States
Introduction: Two necessary components of a patient blood management program are education regarding evidence-based transfusion guidelines and computerized provider order entry (CPOE) with clinician decision support (CDS).[1,2] One particular challenge in a large urban tertiary care academic medical center is the large number of massively transfused patients, making the opportunity for blood conservation more difficult in this setting. This retrospective study examines changes in red blood cell (RBC) utilization through a period of education followed by introduction of CPOE with CDS, with specific attention to surgical services with high rates of massive transfusion.

Methods: After IRB approval, we reviewed 5 years of blood utilization data (2009-2013) for 70,118 surgical patients from 10 different surgical services at a tertiary care academic medical center. Blood utilization data were acquired from a web-based blood management intelligence portal (IMPACT OnLine, Haemonetics Corp., Braintree, MA). Three distinct time periods were compared: 1) Pre-blood management, 2) Education alone, and 3) Education + CPOE. The annualized number of red blood cell (RBC) units transfused was compared to assess changes in blood utilization for the different surgical services. Cost savings were estimated using RBC acquisition cost ($220/unit). Massive transfusions (≥10 RBC units) were also compared between services, to determine if reduced utilization occurred for surgical services with high massive transfusion rates.

Results: For all surgical services combined, RBC utilization decreased by 16.4% with education alone, followed by an increase of 2.5% after adding CPOE (Figure 1). When the time period of Education + CPOE was compared to the Pre-blood management period, the overall decrease was 14.3% (2,102 less RBC units/year or a cost reduction of $462,440/year). Figure 2 shows the 10 surgical services, comparing the percentage of patients that were massively transfused, and the percentage of RBC units given to massively transfused patients. The transplant, cardiac, and vascular surgery services had the most massive transfusions and also the least reduction in RBC utilization.

Conclusions: Adding CPOE with CDS after a successful education effort to promote evidence-based transfusion practice had no impact in further reducing RBC utilization. Patient blood management efforts to reduce RBC utilization were less successful in surgical services with the greatest number of massively transfused patients. Our findings suggest that CPOE may have little influence on transfusion practice in surgical patients, and that blood conservation is more difficult to achieve when greater that 50% of all RBC units are given to massively transfused patients.

References:

1. Shaz BH, et al. JAMA Surg 2013;148:491-2.

2. Yazer MH, et al. TRANSFUSION 2012;51:2500-9.
Figure 1

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