Electronic medical records enable best practices in blood transfusions

BY implementing a “best practice alert” function in electronic medical records, pathologists at Dartmouth-Hitchcock Medical Center in Lebanon, New Hampshire has significantly reduced physicians’ orders for two-unit transfusions for non-bleeding patients. The program, published in Transfusion, enabled physicians ordering transfusions to comply with evidence-based best practices, except in unusual circumstances.

 

“We figured out how to harness the power of the electronic medical record to embed evidence based transfusion criteria into the computerized physician order entry process through the best practices alert functionality,” explained Nancy M. Dunbar, M.D., author of the study. 

 

Dr. Dunbar along with her colleagues are from the Departments of Pathology and Medicine at the Dartmouth-Hitchcock Medical Center. Co-author Swaroopa Yerrabothala is a hematology-oncology fellow at Dartmouth-Hitchcock’s Norris Cotton Cancer Center.

 

New guidelines were the impetus for Dr. Dunbar and colleagues to review their transfusion practices, where they found that not all providers were following evidence-based guidelines. She notes that, at large academic medical centers, it can be difficult to disseminate information to providers and education efforts may only result in temporary changes.

 

By using the electronic medical record to inform physicians of best practices at the time of each transfusion order, the pathologists provided real-time education and reminders at the moment of each order. Study results show the proportion of two-unit transfusions decreased in the period after the implementation of the electronic best practices alert, from 47 percent to 15 percent.

 

“This project in transfusion practice highlights the potential for information technology to potentially improve the quality of medical care in many other sites at our institution,” added Dr. Dunbar.

 

The collaborators continue to monitor provider transfusion practices, and provide targeted near-time education to those that may continue to practice outside of evidence-based criteria. They also partner with clinicians to identify scenarios where the transfusion criteria may need to be modified based on evolving evidence.

 

“Best practices in transfusion medicine are updated continuously and it is our role in pathology to adopt the changes for our institution and spread the word,” explained Dr. Dunbar. “The electronic medical record has proved to be the ideal way to get information about those changes to clinicians at just the time they need it.”