Thrombocytopenia
Conditions
Keywords
Electronic Health Records, Best Practice Alerts
Brief summary
This study is to determine the effectiveness of a computerized clinical decision support tool (Best Practice Alert - BPA) in reducing unnecessary platelet transfusions based on guidelines published by national transfusion societies such as the AABB (formerly American Association of Blood Banks).
Detailed description
A computerized alert will be deployed through the electronic health record. The alert will trigger when a provider orders platelet transfusion above a threshold supported by current guidelines. The alert will provide information on current evidence and give the provider the option to cancel the order or proceed. The alert will not be triggered in procedural areas such as the operating room or as part of any emergency orders to prevent any delays to urgent patient care. The proposed project will evaluate this alert by randomizing its implementation by patient chart. The investigators will observe the prevalence of this alert and its impact on ordering practices for the next 3 months. For patient charts randomized not to receive the intervention, the providers will not receive any alerts, but the analytics tool will record if the alert would have been triggered and the pertinent clinical information. After a period of three months, the investigators will review patient and provider information through analytics tools, assessing differences in platelet usage between the patients whose charts showed the alerts vs. those (control) patient charts not showing alerts.
Interventions
OTHERComputer electronic health record alert (Best Practice Alert - BPA)
Upon ordering platelets in patients with recent platelet count \>50,000, a pop-up within the electronic health system will recommend to not continue with transfuse product order and provide clinical exceptions to continue. Importantly, the alert does not trigger in operating areas, emergency medicine treatment areas, for certain specialties like neurosurgery or for massive transfusion orders.
Sponsors
Stanford University
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
OTHER
Masking
NONE
Eligibility
Sex/Gender
ALL
Healthy volunteers
No
Inclusion criteria
* Recent platelet count \>50k/uL * Platelet transfusion ordered
Exclusion criteria
* Neurosurgery * Procedure area (OR, catheterization lab, interventional radiology suite) * Documented history of antiplatelet agent
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Platelet transfusions above threshold | Data will be initially reviewed before 6 months from start with anticipated completion 1 year from start | Number of platelet transfusions occurring in patients with recent platelet counts above 50k/uL |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Total platelet transfusions | Data will be initially reviewed before 6 months from start with anticipated completion 1 year from start | Total number of platelet transfusions occurring during study period. |
Countries
United States
Outcome results
None listed