Fernández Pérez ER, Winters JL, Gajic O. The addition of decision support into computerized physician order entry reduces red blood cell transfusion resource utilization in the intensive care unit

Mayo Clinic College of Medicine, Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN 55905, USA.
American Journal of Hematology (Impact Factor: 3.8). 07/2007; 82(7):631-3. DOI: 10.1002/ajh.20888
Source: PubMed


Computerized physician order entry (CPOE) has the potential for cost containment in critically ill patients through practice standardization and elimination of unnecessary interventions. Previous study demonstrated the beneficial short-term effect of adding a decision support for red blood cell (RBC) transfusion into the hospital CPOE. We evaluated the effect of such intervention on RBC resource utilization during the two-year study period. From the institutional APACHE III database we identified 2,200 patients with anemia, but no active bleeding on admission: 1,100 during a year before and 1,100 during a year after the intervention. The mean number of RBC transfusions per patient decreased from 1.5 +/- 1.9 units to 1.3 +/- 1.8 units after the intervention (P = 0.045). RBC transfusion cost decreased from $616,442 to $556,226 after the intervention. Hospital length of stay and adjusted hospital mortality did not differ before and after protocol implementation. In conclusion, the implementation of an evidenced-based decision support system through a CPOE can decrease RBC transfusion resource utilization in critically ill patients.

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Available from: Jeffrey Lawrence Winters, Feb 17, 2015
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    • "Not stated (%change only) Not stated Not stated 5% saving Fernández Pérez et al [13] US dollars $616 442 $556 226 (+$600 for DSS implementation) $59 616 saving Goodnough et al [18] "
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    ABSTRACT: Decision support systems (DSSs) provide clinicians with tailored treatment recommendations by combining individual patient information and local guidelines. The objective of this systematic review was to assess the effects of electronic DSS on blood product ordering practices. Eligible studies were identified from searches of MEDLINE, Embase, CINAHL, The Cochrane Library, PubMed, and the Transfusion Evidence Library from January 2000 to April 2014. Of these, 23 articles were eligible, resulting in the inclusion of 20 independent studies in this systematic review. There was a significant variation in study population, the type of DSS used, and outcome reporting. All but one study used a before-after design without any element of randomization. Overall, there is good evidence that implementation of a DSS improves red blood cell usage. The effect of a DSS on plasma, platelets, and cryoprecipitate usage is less clear probably because fewer studies have been conducted focusing on these products. In addition, the introduction of a DSS resulted in cost savings in the 7 studies that reported financial outcomes. Patient outcomes were generally not studied in detail, and there were few data on the sustainability of the effect of DSS. Further data are needed to assess the effect of a DSS on blood products other than red blood cell, and future studies should standardize reporting of outcomes. Copyright © 2014 Elsevier Inc. All rights reserved.
    Transfusion Medicine Reviews 11/2014; 29(1). DOI:10.1016/j.tmrv.2014.10.002 · 2.92 Impact Factor
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    • "These studies included two RCTs [62,71], with the remainder of studies having a quasi-experimental design. Of these studies, five reported a statistically and clinically significant improvement in a cost measure [33,35,36,62,71]. Except in one case as outlined, the cost involved in implementing these interventions was not studied. "
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    BMC Medical Informatics and Decision Making 12/2013; 13(1):135. DOI:10.1186/1472-6947-13-135 · 1.83 Impact Factor
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    • "Health information technology (HIT) has been identified as a critical tool for improving medical care and treatment while holding down costs [1-3]. HIT has the potential to improve the quality and efficiency of medical care through more informed decision making, enhanced communication with patients, better tracking of clinical indicators and medical records, and improved management of databases about diseases and treatments [1,3-9]. Within the United States (US), HIT has become an essential component of efforts to reform the healthcare system, including support within the American Recovery and Reinvestment Act of 2009 for the adoption of electronic medical records and within the Health Information Technology for Economic and Clinical Health Act to aid in the development of a nationwide HIT infrastructure [10]. "
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    ABSTRACT: Concerns about the confidentiality of personal health information have been identified as a potential obstacle to implementation of Health Information Exchanges (HIEs). Considering the stigma and confidentiality issues historically associated with human immunodeficiency virus (HIV) disease, we examine how trust-in technology, processes, and people-influenced the acceptability of data sharing among stakeholders prior to implementation of six HIEs intended to improve HIV care in parts of the United States. Our analyses identify the kinds of concerns expressed by stakeholders about electronic data sharing and focus on the factors that ultimately facilitated acceptability of the new exchanges. We conducted 549 surveys with patients and 66 semi-structured interviews with providers and other stakeholders prior to implementation of the HIEs to assess concerns about confidentiality in the electronic sharing of patient data. The patient quantitative data were analyzed using SAS 9.2 to yield sample descriptive statistics. The analysis of the qualitative interviews with providers and other stakeholders followed an open-coding process, and convergent and divergent perspectives emerging from those data were examined within and across the HIEs. We found widespread acceptability for electronic sharing of HIV-related patient data through HIEs. This acceptability appeared to be driven by growing comfort with information technologies, confidence in the security protocols utilized to protect data, trust in the providers and institutions who use the technologies, belief in the benefits to the patients, and awareness that electronic exchange represents an enhancement of data sharing already taking place by other means. HIE acceptability depended both on preexisting trust among patients, providers, and institutions and on building consensus and trust in the HIEs as part of preparation for implementation. The process of HIE development also resulted in forging shared vision among institutions. Patients and providers are willing to accept the electronic sharing of HIV patient data to improve care for a disease historically seen as highly stigmatized. Acceptability depends on the effort expended to understand and address potential concerns related to data sharing and confidentiality, and on the trust established among stakeholders in terms of the nature of the systems and how they will be used.
    Implementation Science 04/2012; 7(1):34. DOI:10.1186/1748-5908-7-34 · 4.12 Impact Factor
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