The impact of electronic decision support on transfusion practice: a systematic review

Written by: Stephen P. Hibbs, Nathan D. Nielsen, Susan Brunskill, Carolyn Doree, Mark H. Yazer, Richard M. Kaufman, and Michael F. Murphy

Introduction

The purpose of this paper is to make a systematic review of studies examining the effects of clinical decision support system (CDSS) on the following: 1) prescriber compliance on blood transfusion guidelines, 2) average pre-transfusion blood counts or coagulation parameters as a surrogate of compliance, 3) amount of blood usage, 4) financial outcomes, 5) patient outcomes, 6) educational outcomes, and 7) clinician workflows.

Methods

A search was made through MEDLINE with the following criteria for studies: 1) discuss and investigate use of a decision support system for blood ordering, 2) give recommendations for transfusion of red blood cell (RBC), plasma, platelets, and/or cryoprecipitae, an d 3) report outcomes of interest: 1) prescriber compliance on blood transfusion guidelines, 2) average pre-transfusion blood counts or coagulation parameters as a surrogate of compliance, 3) amount of blood usage, 4) financial outcomes, 5) patient outcomes, 6) educational outcomes, and 7) clinician workflows.

Results

20 studies, between the years 2003 to 2014, were reviewed where all but one of the studies used a before and after study design. There was significant variation in populations, types of CDSS, and outcome reporting.

Discussion

Overall the studies show good effects of CDSS on improving prescriber compliance, and reducing pre-transfusion blood counts and RBC usage. The studies showed less evidence of good effects of CDSS on transfusion of plasma, platelets and cryoprecipitate, and patient outcomes. All of the studies show cost savings in financial outcomes.

Conclusion

The researchers believe that there should be further research on the effects of CDSS on: 1) prescriber compliance on blood transfusion guidelines, 2) average pre-transfusion blood counts or coagulation parameters as a surrogate of compliance, 3) amount of blood usage, 4) financial outcomes, 5) patient outcomes, 6) educational outcomes, and 7) clinician workflows. There should be more of a standardization in future studies concerning population, number of transfusions per patient, and time.

Comment

This is an interesting article because compares different studies and the effects of CDSS on blood transfusion outcomes. The ultimate goal of CDSS is to improve patient care but this article suggests that there is little evidence of CDSS improving patient care.

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