Evidence-Based Medical Practice and the Outcomes of Education.
Young Choi, Lisa Krause. Yale School of Medicine, Bridgeport, CT; Bridgeport Hospital, CT
Background: The risks and increasing cost of blood products have lead to a heightened interest by the regulatory agencies to develop a blood management program for a safe and cost-effective use of blood products. Education to all level of the health care personnel is crucial in achieving the effective blood management program. Pathologists should play the forefront role in evidence-based transfusion services.
Design: We have conducted (1) ongoing in-service education, (2) retrospective and prospective audits and discussion with the clinicians for the appropriate usage, and (3) implemented the Computer Physician Order Entry (CPOE) with the guidelines. The guidelines were developed by reviewing published data and those used in various hospitals, and included many potential reasons for which clinicians may order blood products. Prior to implementing the CPOE, we sought feed back and decision support from multidisciplinary team. Prospective and retrospective audits were conducted to assess the degree of compliance, the frequency of bypass and overrides /”other reasons” with explanations. Then, the usage of blood products and the cost were analyzed.
Results: Of all orders during a 12 month period, “other reasons” were 0.9% (50/5043) for red blood cells (RBC), 19.0% (268/1399) for fresh frozen plasma (FFP) and 18.7% (206/1099) for platelets (PLT). A wide range of the indicators listed in the RBC CPOE has resulted in the low number of “other reasons” in the COPE indicators. “Other reasons” for FFP and PLT orders originated mostly from the patients with open heart surgery, minor invasive procedures, neurosurgery, bleeding from GI or other sources, and liver failure. Upon auditing, not always laboratory data substantiated the reasons for transfusion. In some “other reasons”, it was necessary for medical director to have a lengthy discussion with the clinicians to modify the orders. Overall, there was about 5% reduction in the utilization of blood products and its associated cost during this period.
Conclusions: Evidence-based transfusion practices require ongoing education, continued audits of the orders and direct open dialogue with the clinicians, and prospective and front-end interventions targeted at the deciding provider. The CPOE implementation achieved consistency in ordering patterns and educational opportunities for the clinicians, and greater ease in monitoring transfusion appropriateness. Continued review of “other reasons” with the modification for patient-specific predictors in the CPOE has facilitated the compliance by the clinicians.
Tuesday, March 1, 2011 9:30 AM
Poster Session III # 140, Tuesday Morning