Adequacy of physician documentation and correlation with assessment of transfusion appropriateness: a follow‐up study in the setting of prospective audits and patient blood management

Madrigal, Emilio; Prajapati, Shyam; Avadhani, Vaidehi; Annen, Kyle; Friedman, Mark T.

doi:10.1111/trf.13917

Cited by 11 publications

(7 citation statements)

References 13 publications

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“…The included studies were published between 1983 32 and 2017, 33–38 with the majority of studies conducted in the USA (n=50). Only three studies were RCTs (one cluster RCT, two randomised at the individual level) 31 39 40 ; the remaining 81 were non-randomised studies, specifically uncontrolled before and after (n=74) 29–31 33–36 38 41–106 ; controlled before and after (n=2) 107 108 ; interrupted time series (n=1) 37 and non-randomised trial (n=4) 32 109–111 designs.…”

Section: Resultsmentioning

confidence: 99%

“…The following single intervention categories were identified: education sessions or materials (n=9) 40 80–86 109 , protocols or algorithms (n=7) 39 90–95 , guidelines (n=4) 87–89 110 , computerised physician order entry (CPOE) systems and decision support (n=4) 31 97–99 , reminders (n=2) 100 108 , audit and feedback (n=2) 101 111 , audit approval (n=2) 102 103 , a clinical policy (n=1) 96 and prospective audit of transfusion practices (n=1). 37 Descriptions of each, along with examples from the included studies, are provided in table 1 .…”

Section: Resultsmentioning

confidence: 99%

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Behaviour modification interventions to optimise red blood cell transfusion practices: a systematic review and meta-analysis

et al. 2018

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ObjectiveTo assess the impact of behaviour modification interventions to promote restrictive red blood cell (RBC) transfusion practices.DesignSystematic review and meta-analysis.Setting, participants, interventionsSeven electronic databases were searched to January 2018. Published randomised controlled trials (RCTs) or non-randomised studies examining an intervention to modify healthcare providers’ RBC transfusion practice in any healthcare setting were included.Primary and secondary outcomesThe primary outcome was the proportion of patients transfused. Secondary outcomes included the proportion of inappropriate transfusions, RBC units transfused per patient, in-hospital mortality, length of stay (LOS), pretransfusion haemoglobin and healthcare costs. Meta-analysis was conducted using a random-effects model and meta-regression was performed in cases of heterogeneity. Publication bias was assessed by Begg’s funnel plot.ResultsEighty-four low to moderate quality studies were included: 3 were RCTs and 81 were non-randomised studies. Thirty-one studies evaluated a single intervention, 44 examined a multimodal intervention. The comparator in all studies was standard of care or historical control. In 33 non-randomised studies, use of an intervention was associated with reduced odds of transfusion (OR 0.63 (95% CI 0.56 to 0.71)), odds of inappropriate transfusion (OR 0.46 (95% CI 0.36 to 0.59)), RBC units/patient weighted mean difference (WMD: −0.50 units (95% CI −0.85 to −0.16)), LOS (WMD: −1.14 days (95% CI −2.12 to −0.16)) and pretransfusion haemoglobin (−0.28 g/dL (95% CI −0.48 to −0.08)). There was no difference in odds of mortality (OR 0.90 (95% CI 0.80 to 1.02)). Protocol/algorithm and multimodal interventions were associated with the greatest decreases in the primary outcome. There was high heterogeneity among estimates and evidence for publication bias.ConclusionsThe literature examining the impact of interventions on RBC transfusions is extensive, although most studies are non-randomised. Despite this, pooled analysis of 33 studies revealed improvement in the primary outcome. Future work needs to shift from asking, ‘does it work?’ to ‘what works best and at what cost?’PROSPERO registration numberCRD42015024757.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Behaviour modification interventions to optimise red blood cell transfusion practices: a systematic review and meta-analysis

et al. 2018

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“…The risks for the patient, the reduced availability of RBCs due to a decline in blood donations, and ultimately the costs, are essential factors in PBM. The justification for every transfusion according to the current guidelines must be documented for the reasons mentioned elsewhere [ 51 , 52 , 53 , 54 ]. The value for tHb is decisive in this respect [ 14 , 51 , 52 ].…”

Section: Discussionmentioning

confidence: 99%

Current Status of Measurement Accuracy for Total Hemoglobin Concentration in the Clinical Context

et al. 2022

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Objective: The main objective of this investigation is to provide data about the accuracy of total hemoglobin concentration measurements with respect to clinical settings, and to devices within the categories of point-of-care and reference systems. In particular, tolerance of hemoglobin concentrations below 9 g/dL that have become common in clinical practice today determines the need to demonstrate the limits of measurement accuracy in patient care. Methods: Samples extracted from six units of heparinized human blood with total hemoglobin concentrations ranging from 3 to 18 g/dL were assigned to the test devices in a random order. The pool of test devices comprised blood gas analyzers, an automatic hematology analyzer, a laboratory reference method, and the point-of-care system HemoCue. To reduce the pre-analytic error, each sample was measured three times. Due to the characteristics of the tested devices and methods, we selected the mean values of the data from all these devices, measured at the corresponding total hemoglobin concentrations, as the reference. Main results: The measurement results of the test devices overlap within strict limits (R2 = 0.999). Only the detailed analysis provides information about minor but systematic deviations. In the group of clinically relevant devices, which are involved in patient blood management decisions, the relative differences were within the limit of +/− 5 % for values down to 3 g/dL. Conclusions: A clinically relevant change of +/− 0.5 g/dL of total hemoglobin concentration can be detected with all selected devices and methods. Compliance with more stringent definitions—these are the relative differences of 5 % in relation to the corresponding reference values and the clinically adapted thresholds in the format of a tolerance level analysis—was achieved by the clinical devices assessed here.

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“…It is encouraging, though, that many respondents implemented other methods, such as prospectively auditing RBC and platelet orders. Prospective auditing, which can be performed by laboratory personnel such as pathology residents and medical laboratory technologists, reduces unnecessary transfusions, and can be a component of a successful patient blood management program 12–14 …”

Section: Discussionmentioning

confidence: 99%

Hospital transfusion service operations during the SARS‐CoV‐2 pandemic: Lessons learned from the AABB hospital survey in preparation for the next infectious disease outbreak

et al. 2021

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Background The SARS‐CoV‐2 pandemic disrupted hospital operations, affected the blood supply, and challenged the health care system to develop new therapeutic options, including convalescent plasma (CCP). The aim of this study is to describe and analyze blood supply fluctuations and the use of convalescent plasma in 2020. Methods AABB distributed a weekly and biweekly questionnaire through email to hospital‐based members (HBM). Results The survey was sent to 887 HBM with 479 unique respondents, most of the hospitals served pediatric and adult patients, and all states of the country participated, except Idaho and Vermont. Fifty four percent of HBM reported increased wastage in the early phase of the pandemic (May), which decreased to 4% by the end of June and throughout the rest of the year. The majority of HBM reported receiving alerts from their blood suppliers reporting blood shortages throughout the year. During March and April, only 12% of HBM were performing elective surgical procedures. The top reasons to delay procedures were: bed availability (28%); COVID‐19 caseload (23%; and blood availability (19%). By mid‐April, 42% HBM had transfused CCP and reported >24 h delay in getting the units; the vast majority obtained CCP using the Expanded Access Protocol, and later, the Emergency Use Authorization. HBM consistently prioritized the most severe patients to receive CCP, but the proportion of severely ill recipients fell from 52% to 37% between May and October, with an increase from 5% to 21% of HBM providing CCP transfusion early in the course of the disease. Discussion Blood utilization and availability fluctuated during the pandemic. The fluctuations appeared to be related to the number of COVID‐19 in the community. The use and regulatory landscape of CCP rapidly evolved over the first 8 months of the pandemic.

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Adequacy of physician documentation and correlation with assessment of transfusion appropriateness: a follow‐up study in the setting of prospective audits and patient blood management

Cited by 11 publications

References 13 publications

Behaviour modification interventions to optimise red blood cell transfusion practices: a systematic review and meta-analysis

Behaviour modification interventions to optimise red blood cell transfusion practices: a systematic review and meta-analysis

Current Status of Measurement Accuracy for Total Hemoglobin Concentration in the Clinical Context

Hospital transfusion service operations during the SARS‐CoV‐2 pandemic: Lessons learned from the AABB hospital survey in preparation for the next infectious disease outbreak

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