Evidence-based red cell transfusion in the critically ill: Quality improvement using computerized physician order entry
Written by Rimki Rana, Bekele Afessa, Mark T. Keegan, Francis X. Whalen Jr., Gregory A. Nuttall, Laura K. Evenson, Steve G. Peters, Jeffrey L. Winters, Rolf D. Hubmayr, S. Breanndan Moore, and Ognjen Gajic. 
The authors developed a computerized provider order entry (CPOE) combined with a clinical decision support (CDS) algorithm. They then compared the utilization of red blood cell (RBC) transfusion, the proportion of patients who receive RBC transfusions outside of recommended guidelines, adjusted hospital mortality rate, length of stay at hospital, and the rate of transfusion complications with ischemic cardiovascular complications before and after implementation of new system.
Data was collected from three adult ICUs, one surgical, one medical, and one surgical and medical from January 1, 2005 to April 1, 2005 (after implementation) and January 1, 2004 to April 1, 2004 (prior to implementation). Variables the authors considered were general patient characteristics and transfusion factors.
The number of RBC units and the number of inappropriate transfusions decreased after implementation. However, the rate of patients with complications who received a transfusion did not significantly change between the two periods.
The authors found that they a reduction in patients receiving RBC transfusions by 20% due to the new CPOE protocol. This new protocol also shows a reduction in number of transfusion complications, however there was no change in ICU length of stay, ICU free days, and mortality.
The authors found the new CPOE protocol as useful but should be combined with education, decision support, and protocol.
This is an interesting article because it provides a direct comparison of CPOE with providing help in decreasing blood transfusions. I was a little disappointed in the lack of change with mortality between periods but it is a small study limited with one hospital. Maybe the authors are right, the combination of CPOE, education, and CDS is what is needed.
- Rana, R., Afessa, B., Keegan, M. T., Whalen, F. X., Nuttall, G. A., Evenson, L. K., Peters, S. G., Winters, J. L., Hubmayr, R. D., Moore, S B., & Gajic, O. (2006). Evidence-based red cell transfusion in the critically ill: Quality improvement using computerized physician order entry. Critical Care Medicine, 34(7), 1892-1897. doi: 10.1097/01.CCM.0000220766.13623.FE