Background/Case Studies: Patient blood management (PBM) best practice alerts (BPA) have two goals: prevent unnecessary transfusions and provide cost avoidance. This study was to determine if the BPA achieved the two goals (help) or if it did not (hindrance).
Study
Design/Methods: The PBM program of a three-hospital 521-bed system implemented a BPA for transfusions that did not meet thresholds as defined in approved standard operating procedures (SOPs) as follows: red blood cells (RBCs) with hemoglobin of > 7 g/dL or > 8 g/dL with cardiovascular disease; platelet transfusion without clinical evidence of bleeding and a platelet count of >10,000/uL, or placement of the central venous catheter and a platelet count of >20,000/uL; and plasma transfusion without acute bleed or prior to an invasive procedure and INR < 1.5. The BPA provided the first line of the relevant transfusion threshold procedure, a hyperlink to the full procedure, the three most recent relevant laboratory values (i.e., for red blood cell orders – hemoglobin and hematocrit), and a button to either accept or cancel the order. The study period was from January 1, 2016, through December 31, 2022. The total number of units transfused, number of units, and percent of units canceled due to the BPA and cost savings by blood component were calculated. Hospital blood product acquisition costs were adjusted each year as pricing changed.
Results/Findings: During the study period, 1,241 unit orders (1.6%) out of 79,027 unit orders were canceled due to the BPA. Total unit orders canceled and cost avoidance were: RBC 1,045/$209,159.43, platelets 120/$53,898.48, and plasma 76/$4,276.16 for a total of $267,334.07 US dollars (USD). Conclusions: PBM achieved both of its goals by preventing unnecessary transfusions through the use of the BPA and it resulted in cost avoidance. The creation of a BPA that informed an ordering provider when the transfusion order fell outside of hospital-defined SOPs provided the necessary information needed to make an informed decision prior to finalizing the transfusion order. At this hospital system implementation of a transfusion threshold BPA was helpful.
Importance of research: The creation of a best practice alert (BPA) notified an ordering provider when the transfusion order fell outside of hospital-defined standard operating procedures (SOP). It also provided the necessary information needed to make an informed decision prior to finalizing the transfusion order. Implementation of the BPA resulted in both transfusion avoidance and cost savings and was determined to be helpful to this hospital system.
