Improving blood transfusion practice: role of a computerized hospital information system

Abstract

The recent focus on medical risk and financial cost has prompted a need for better guidelines for prescribing the transfusion of blood components. In 1987, to respond to the issues of quality transfusion practice and accurate evaluation, LDS Hospital (Salt Lake City, UT) began using a computerized, knowledge-based blood-ordering system. Each transfusion request was reviewed and flagged by the computer when it did not meet the criteria established by the medical staff. The study reviewed the use of red cells, platelets, and fresh-frozen plasma in 13,082 transfusion orders for 5847 consecutive patients from July 1, 1988, through June 30, 1989. The evaluation assessed, first, the adherence of physicians to computerized criteria and, second, their adherence to the quality of transfusion practice. A high percentage of the blood units ordered met the established criteria: 91.2 percent for the red cell transfusions, 72.9 percent for platelets, and 81.7 percent for fresh-frozen plasma. From the July 1, 1987, implementation date through June 1989, the mean hematocrit of persons being transfused dropped from 28.6 to 27.7 percent (0.29 = 0.28) (p less than 0.005) and the number of orders requiring review by the quality assurance department dropped from 100 to 14 percent; moreover, there was a true-exception rate of only 0.37 percent. The use of the computer system effected the implementation of the following measures: 1) identification of the indications and establishment of clear clinical and biologic parameters for every transfusion, and 2) measurement and improvement of institutional transfusion practice. These results demonstrated the efficacy of a computerized hospital information system in implementing continuous quality improvement for transfusion practice.(ABSTRACT TRUNCATED AT 250 WORDS)

Electronic Health Record Features, Functions, and Privileges That Clinicians Need to Provide Safe and Effective Care for Adults and Children

“…Clinicians have a right to override, but not permanently disable, any computer-generated clinical alert, except those prohibiting events that should never occur (e.g., ordering promethazine as intravenous push by peripheral vein [ 46 ]). software bugs); situation-specifi c clinical exceptions, as when a user's request for blood transfusion is denied by Clinical Decision Support (CDS) intervention that did not capture active bleeding since last hemoglobin result [ 47 ]; and, user-interface limitations, such as in limited screen space available to show most recent laboratory results near medication order [ 48 ]. In reality, computers are often not able to interpret or convey the clinical context for many reasons: unavailable or inaccurate data; errors in logical processing (e.g.…”

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“…14. 15 These same principles can be carried over to cost containment efforts by giving suggestions to physicians to use less costly antibiotics for the given diagnosis and bacteriology results. ~6.~7 Reminders to stop medications have also proven to be very effective at reducing costs and improving the quality of care, especially in the area of prophylactic perioperative antibiotics.…”