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
    • "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.
    No preview · Article · Nov 2014 · Transfusion Medicine Reviews
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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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