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Adkins BD, Murfin R, Luu HS, Noland DK. Paediatric clinical decision support: Evaluation of a best practice alert for red blood cell transfusion. Vox Sang 2023; 118:746-752. [PMID: 37431735 DOI: 10.1111/vox.13497] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Revised: 06/27/2023] [Accepted: 06/28/2023] [Indexed: 07/12/2023]
Abstract
BACKGROUND AND OBJECTIVES Providing red blood cell (RBC) transfusion to paediatric patients with a haemoglobin (Hb) level of <7 g/dL is the current best practice, but it is often difficult to ensure appropriateness of RBC transfusion on a health system level. Electronic health record (EHR) clinical decision support systems have been shown to be effective in encouraging providers to transfuse at appropriate Hb thresholds. We present our experience with an interruptive best practice alert (BPA) at a paediatric healthcare system. MATERIALS AND METHODS An interruptive BPA requiring physician response was implemented in our EHR (Epic Systems Corp., Verona, WI, USA) in 2018 based on Hb thresholds for inpatients. The threshold was initially <8 g/dL and later changed to <7 g/dL in 2019. We assessed total activations, number of RBC transfusions and hospital metrics through 2022 compared to the 2 years prior to implementation. RESULTS The BPA activated 6956 times over 4 years, slightly less than 5/day, and the success rate, with no RBC transfusions within 24 h of order attempt, was 14.5% (1012/6956). There was a downward trend in the number of total RBC transfusions and RBC transfusions per admission after implementation, non-significant (p = 0.41 and p = >0.99). The annual case mix index was similar over the years evaluated. The estimated cost savings based on acquisition costs for RBC units were 213,822 USD or about $51,891 per year. CONCLUSION BPA implementation led to sustained change in RBC transfusion towards best practice, and there were long-term savings in RBC expenditure.
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Affiliation(s)
- Brian D Adkins
- Department of Pathology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
- Department of Pathology, Children's Health, Dallas, Texas, USA
| | - Roberta Murfin
- Department of Pathology, Children's Health, Dallas, Texas, USA
| | - Hung S Luu
- Department of Pathology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
- Department of Pathology, Children's Health, Dallas, Texas, USA
| | - Daniel K Noland
- Department of Pathology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
- Department of Pathology, Children's Health, Dallas, Texas, USA
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Schilling M, Rickmann L, Hutschenreuter G, Spreckelsen C. Reduction of Platelet Outdating and Shortage by Forecasting Demand With Statistical Learning and Deep Neural Networks: Modeling Study. JMIR Med Inform 2022; 10:e29978. [PMID: 35103612 PMCID: PMC8848235 DOI: 10.2196/29978] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Revised: 09/12/2021] [Accepted: 11/21/2021] [Indexed: 11/13/2022] Open
Abstract
Background Platelets are a valuable and perishable blood product. Managing platelet inventory is a demanding task because of short shelf lives and high variation in daily platelet use patterns. Predicting platelet demand is a promising step toward avoiding obsolescence and shortages and ensuring optimal care. Objective The aim of this study is to forecast platelet demand for a given hospital using both a statistical model and a deep neural network. In addition, we aim to calculate the possible reduction in waste and shortage of platelets using said predictions in a retrospective simulation of the platelet inventory. Methods Predictions of daily platelet demand were made by a least absolute shrinkage and selection operator (LASSO) model and a recurrent neural network (RNN) with long short-term memory (LSTM). Both models used the same set of 81 clinical features. Predictions were passed to a simulation of the blood inventory to calculate the possible reduction in waste and shortage as compared with historical data. Results From January 1, 2008, to December 31, 2018, the waste and shortage rates for platelets were 10.1% and 6.5%, respectively. In simulations of platelet inventory, waste could be lowered to 4.9% with the LASSO and 5% with the RNN, whereas shortages were 2.1% and 1.7% with the LASSO and RNN, respectively. Daily predictions of platelet demand for the next 2 days had mean absolute percent errors of 25.5% (95% CI 24.6%-26.6%) with the LASSO and 26.3% (95% CI 25.3%-27.4%) with the LSTM (P=.01). Predictions for the next 4 days had mean absolute percent errors of 18.1% (95% CI 17.6%-18.6%) with the LASSO and 19.2% (95% CI 18.6%-19.8%) with the LSTM (P<.001). Conclusions Both models allow for predictions of platelet demand with similar and sufficient accuracy to significantly reduce waste and shortage in a retrospective simulation study. The possible improvements in platelet inventory management are roughly equivalent to US $250,000 per year.
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Affiliation(s)
- Maximilian Schilling
- Institute for Medical Informatics, University Hospital Aachen, RWTH Aachen University, Aachen, Germany
| | - Lennart Rickmann
- Institute for Medical Informatics, University Hospital Aachen, RWTH Aachen University, Aachen, Germany
| | - Gabriele Hutschenreuter
- Institute for Transfusion Medicine, University Hospital Aachen, RWTH Aachen University, Aachen, Germany
| | - Cord Spreckelsen
- Institute of Medical Statistics, Computer and Data Sciences, Jena University Hospital, Friedrich Schiller University, Jena, Germany
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Crispin P, Akers C, Brown K, Delaforce A, Keegan A, King F, Ormerod A, Verrall T. A review of electronic medical records and safe transfusion practice for guideline development. Vox Sang 2022; 117:761-768. [PMID: 35089600 DOI: 10.1111/vox.13254] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2021] [Revised: 10/22/2021] [Accepted: 11/26/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND AND OBJECTIVES Electronic medical records (EMRs) are often composed of multiple interlinking systems, each serving a particular task, including transfusion ordering and administration. Transfusion may not be prioritized when developing or implementing electronic platforms. Uniform guidelines may assist information technology (IT) developers, institutions and healthcare workforces to progress with shared goals. MATERIALS AND METHODS A narrative review of current clinical guidance, benefits and risks of electronic systems for clinical transfusion practice was combined with feedback from experienced transfusion practitioners. RESULTS There is opportunity to improve the safety, quality and efficiency of transfusion practice, particularly through decision support and better identification procedures, by incorporating transfusion practice into EMRs. However, these benefits should not be assumed, as poorly designed processes within the electronic systems and the critically important electronic-human process interfaces may increase risk while creating the impression of safety. CONCLUSION Guidelines should enable healthcare and IT industries to work constructively together so that each implementation provides assurance of safe practice.
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Affiliation(s)
- Philip Crispin
- Clinical Practice Improvement Committee of Australian and New Zealand Society of Blood Transfusion, Sydney, NSW, Australia.,Department of Haematology, Canberra Hospital, Garran, ACT, Australia.,Australian National University Medical School, Acton, ACT, Australia
| | - Christine Akers
- Clinical Practice Improvement Committee of Australian and New Zealand Society of Blood Transfusion, Sydney, NSW, Australia.,Victorian Department of Health and Human Services, Blood Matters Program, Melbourne, Victoria, Australia
| | - Kristen Brown
- Clinical Practice Improvement Committee of Australian and New Zealand Society of Blood Transfusion, Sydney, NSW, Australia.,Medical Services, Murrumbidgee Area Health Service, Wagga Wagga, NSW, Australia
| | - Alana Delaforce
- Clinical Practice Improvement Committee of Australian and New Zealand Society of Blood Transfusion, Sydney, NSW, Australia.,Mater Health Services, South Brisbane, QLD, Australia.,Mater Research Institute-UQ, South Brisbane, QLD, Australia.,School of Nursing and Midwifery, The University of Newcastle, Callaghan, NSW, Australia
| | - Anastazia Keegan
- Clinical Practice Improvement Committee of Australian and New Zealand Society of Blood Transfusion, Sydney, NSW, Australia.,Transfusion Policy and Education, Australian Red Cross Lifeblood, Perth, Western Australia, Australia.,Department of Haematology, Nepean Hospital, New South Wales, Australia
| | - Fiona King
- Clinical Practice Improvement Committee of Australian and New Zealand Society of Blood Transfusion, Sydney, NSW, Australia.,New Zealand Blood Service, Wellington, New Zealand
| | - Amanda Ormerod
- Clinical Practice Improvement Committee of Australian and New Zealand Society of Blood Transfusion, Sydney, NSW, Australia.,Department of Haematology, Latrobe Regional Health, Traralgon, Victoria, Australia
| | - Trudi Verrall
- Clinical Practice Improvement Committee of Australian and New Zealand Society of Blood Transfusion, Sydney, NSW, Australia.,BloodSafe eLearning, Adelaide, South Australia, Australia
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Pandey S, Belanger GA, Rajbhandary S, Cohn CS, Benjamin RJ, Bracey AW, Katz LM, Menitove JE, Mintz PD, Gammon RR. A survey of US hospitals on platelet inventory management, transfusion practice, and platelet availability. Transfusion 2021; 61:2611-2620. [PMID: 34287930 DOI: 10.1111/trf.16561] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Revised: 05/27/2021] [Accepted: 06/04/2021] [Indexed: 12/11/2022]
Abstract
BACKGROUND A survey of US hospitals was conducted to increase our understanding of the current state of platelet (PLT) practice and supply. The survey captures information on transfusion practice and inventory management, including stock levels, outdate rates, ability to return or transfer PLTs, and low dose PLTs. Notably, the survey also elucidates PLT availability challenges and impact to patient care. STUDY DESIGN AND METHODS A 27 question online survey was distributed directly to over 995 US hospitals and indirectly through blood centers to many more between September 27 and October 25, 2019. Descriptive statistics were used for respondent characteristics. Bivariate analysis was performed and correlation coefficients, chi square tests, and p values determined statistical significance of relationships between variables. RESULTS Four hundred and eighty-one hospitals completed the survey of which 21.6%, 53.2%, and 25.2% were characterized as small, medium, and large hospitals, respectively. Some key observations from this survey include: (1) there is an opportunity for greater adherence to evidence-based guidelines; (2) higher outdate rates occur in hospitals stocking less than five PLTs and the ability to return or transfer PLTs lowers outdates; (3) use of low dose apheresis PLTs varies; and (4) decreased PLT availability is commonly reported, especially in hospitals with high usage, and can lead to delays in transfusions or surgeries. CONCLUSION This survey represents a comprehensive national assessment of inventory management practices and PLT availability challenges in US hospitals. Findings from this survey can be used to guide further research, help shape future guidance for industry, and assist with policy decisions.
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Affiliation(s)
- Suchitra Pandey
- Department of Pathology, Stanford University, Palo Alto, California, USA.,Medical Services, Operations Excellence, Stanford Blood Center, Stanford Health Care, Palo Alto, California, USA
| | - Geoffrey A Belanger
- Medical Services, Operations Excellence, Stanford Blood Center, Stanford Health Care, Palo Alto, California, USA
| | | | - Claudia S Cohn
- Department of Research, AABB, Bethesda, Maryland, USA.,Department of Laboratory Medicine and Pathology, University of Minnesota, Minneapolis, Minnesota, USA
| | - Richard J Benjamin
- Clinical Research and Medical Affairs, Cerus Corporation, Concord, California, USA
| | - Arthur W Bracey
- Department of Pathology, Baylor St Luke's Medical Center, Houston, Texas, USA
| | - Louis M Katz
- Medical Affairs, ImpactLife (formerly Mississippi Valley Regional Blood Center), Davenport, Iowa, USA
| | - Jay E Menitove
- Department of Pathology and Lab Medicine, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Paul D Mintz
- Medical Affairs, Verax Biomedical, Inc, Marlborough, Massachusetts, USA
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