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CPOE Reducing I nappropriate Transfusions (CRIT) Collaborative

CPOE Reducing I nappropriate Transfusions (CRIT) Collaborative.

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CPOE Reducing I nappropriate Transfusions (CRIT) Collaborative

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  1. CPOE Reducing Inappropriate Transfusions (CRIT) Collaborative “The most cost effective opportunity to improve patient outcomes in the next quarter century will likely come, not from discovering new therapies but from discovering how to effectively deliver therapies that are known to be effective” Sean Berenholtz 2003

  2. Introduction of Collaborative Participants

  3. Collaborative Goals • Introduce a tool to reduce unnecessary blood transfusions in hospitalized children across multiple institutions. • Test the hypothesis that CPOE tethered to CDS can improve and hasten the adoption of evidence based guidelines across multiple institutions. • Set the framework for future collaborations using effective decision support tools.

  4. Collaborative Benefits • Quality Improvement • Improve transfusion utilization • Significant cost savings • Demonstrate the value of CPOE • Idea sharing • Networking • Academic • Provide the framework to conduct hypothesis driven studies/RCT’sacross multiple institutions • Provide the framework for future collaborations and research projects

  5. Red Blood Cell Transfusions Carry Both Benefits and Risks What are the standard transfusion practices? When is it appropriate to transfuse? When do the benefits outweigh the risk?

  6. Red blood cell transfusions alter immune function

  7. Transfusion Practices are Highly Variable Among Hospital Based Pediatricians Laverdiere PCCM 2002

  8. Barriers to Transforming Data Into Practice Cabana, JAMA 1999 Berenholtz, Current Opinion in Critical Care 2003

  9. Clinical Decision Support and Computerized Physician Order Entry (CPOE) Augments Adherence to Evidence Based Guidelines. Kawamoto BMJ 2005

  10. Study Design

  11. Decision Support Window

  12. In the Acute Care Wards, CPOE Decision Support Decreased Average Pre-transfusion Hemoglobin

  13. In the PICU, CPOE Decision Support Decreased Average Pre-transfusion Hemoglobin

  14. In the PICU, CPOE Decreased Blood Transfusions Per Patient Day

  15. On the Acute Care Wards, CPOE Decreased Blood Transfusions 460 fewer blood transfusions 100 fewer patient exposures

  16. Overall transfusions per patient day

  17. The relative risk of transfusion in the study population versus control

  18. Implementation of a Decision Support Algorithm in Association With CPOE Can: Accelerate adoption of evidence-based guidelines into clinical best practice Decrease overall RBC transfusions in the PICU and pediatric acute care wards without increasing overall hospital mortality or PICU length of stay 460 fewer RBCT delivered to children at LPCH during the study period. The estimated direct cost savings for the blood alone was more than $160,000.00. After accounting for additional indirect costs surrounding blood transfusions, the overall savings is significantly greater.

  19. CRIT Website

  20. Implementation

  21. Next meeting Monday October 24th 10:00 AM Spread the word!

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