Background
Blood transfusions can serve as a life-saving treatment for patients, though inappropriate blood product transfusions can result in patient harm and excess costs for health systems. Despite published evidence supporting restricted packed red blood cell (pRBC) usage, many providers transfuse outside of guidelines. Here we report a novel prospective, randomized control trial to increase guideline-concordant pRBC transfusions comparing three variations of clinical decision support (CDS) in the electronic health record (EHR).
Methods
All inpatient providers at University of Colorado Hospital (UCH) who order blood transfusions are randomized in a 1:1:1 fashion to the three arms of the study: (1) general order set improvements; (2) general order set improvements plus non-interruptive in-line help text alert; (3) general order set improvements plus interruptive alert. Transfusing providers receive their same randomized order set changes for 18 months. The primary outcome of this study is a comparison is between the group using the new interface (arm 1) versus the two groups using the new interface with interruptive or non-interruptive alerts (arms 2 and 3, combined). The secondary outcomes compare guideline-concordant transfusion rate between arm 2 and arm 3 as well as comparing all of arms of the study in aggregate to historical controls. This trial is ongoing.
Discussion
CDS tools can increase guideline concordant behavior. This trial will examine three different CDS tools to determine which type is most effective at increasing guideline concordant blood transfusions.
Trial registration:
Registered on ClinicalTrials.gov 3/20/21, NCT04823273, https://clinicaltrials.gov/ct2/show/NCT04823273. Approved by University of Colorado Institutional Review Board (19-0918).