Outcomes of red blood cell transfusions prescribed in organ donors by the Digital Intern, an electronic decision support algorithm

Abstract

The DI provided transfusion dosing that achieved the desired threshold in the majority of organ donors transfused. Ongoing work focuses on application of this technology to transfusions in general patient populations.

The blood utilization calculator, a target‐based electronic decision support algorithm, increases the use of single‐unit transfusions in a large academic medical center

“…The performance of these algorithms was originally evaluated in the organ donor population where we demonstrated algorithmdetermined doses that meet selected target Hb or Hct levels in 96% of transfusions and improved standardization of transfusion practice. 8,9 In this study we show that implementing the RBC calculator from the DI program into the electronic medical record RBC order set resulted in a significant increase in single-unit transfusions and reduced blood use. The increase in single-unit transfusions in this study was partly the result of defaulting RBC orders to 1 unit.…”

“…UW Health has focused PBM electronic decision support on the development of target‐based, transfusion dose–calculating algorithms. The performance of these algorithms was originally evaluated in the organ donor population where we demonstrated algorithm‐determined doses that meet selected target Hb or Hct levels in 96% of transfusions and improved standardization of transfusion practice . In this study we show that implementing the RBC calculator from the DI program into the electronic medical record RBC order set resulted in a significant increase in single‐unit transfusions and reduced blood use.…”

“…The DI's module for transfusion was shown to improve the standardization of RBC transfusion, in keeping with current transfusion guidelines, and provided RBC doses, in units, that achieved the target Hb or Hct value in more than 96% of the prescribed transfusions. 8,9 Given the promising performance of the DI RBC algorithm in the organ donor population, we expanded the use of the algorithm to other patient populations by embedding the DI's RBC dose calculation into the RBC order set of our electronic medical record, Health Link (Epic). This new version of the algorithm was named the blood utilization calculator or BUC.…”

“…Based on recent hemoglobin (Hb) or hematocrit (Hct) values and the patient's weight, the program uses a proprietary mathematic model and calculates the number of units of RBCs to transfuse to achieve a predefined Hb or Hct target. The DI's module for transfusion was shown to improve the standardization of RBC transfusion, in keeping with current transfusion guidelines, and provided RBC doses, in units, that achieved the target Hb or Hct value in more than 96% of the prescribed transfusions …”

Electronic clinical decision support to facilitate a change in clinical practice: Small details can make or break success

“…Our group has been actively working to optimize the use of CDS in transfusion medicine to improve our providersʼ compliance with good PBM/transfusion guidelines. 4,14,15 Although the majority of PBM decision support research involves the optimal use of red blood cell (RBC) transfusion, ideally, a good PBM program should address the judicious use of all blood products, including plasma. Historically, plasma has been used for the correction of coagulopathy, including both pathologic coagulation defects as well as pharmacologically induced therapeutic anticoagulation, in particular, the reversal of the anticoagulant warfarin.…”