(P-PB-26) Seven-Year Follow-Up of Blood Utilization Calculator (BUC), A Target-Based Integrated Decision Support Algorithm, Shows Improved Acceptance of Calculated Recommendations
Department of Pathology and Laboratory Medicine, University of Wisconsin Hospital and Clinics Madison, WI, USA
Background/Case Studies: Electronic decision support algorithms have been shown to improve proper utilization of red blood cell (RBC) units for transfusion. In 2016 our group began an initiative to reduce unnecessary transfusions through implementation of a hemoglobin/hematocrit (Hgb/HCT) target-based algorithm, the blood utilization calculator or BUC integrated into our electronic medical record for all non-surgical RBC orders. The BUC uses patient weight and pre-transfusion Hgb/HCT level to calculate the appropriate dose, in units of RBCs to raise the patient’s hemoglobin to the selected target. Previously published data from the first 24 months of BUC use demonstrated that the BUC recommended number of units to transfuse was accepted by the ordering provider in 49% of orders placed.In the first 24 months of use the BUC also resulted in a significant increase in single-unit transfusions (p < 0.0001) which resulted in an inversion of the ratio of 1-unit to 2-unit transfusions increased from 0.72 to 1.67 (p < 0.0001). To assess institutional changes in acceptance of the BUC recommendations over time, data from calendar year (2023) was collected, analyzed, and compared to previously published work to evaluate if initially observed improvements in patient blood management were maintained over time.
Study
Design/Methods: The electronic medical record was queried to capture order details for every RBC order that resulted in a BUC recommendation from 1/1/23 to 12/31/23.This data captured both BUC recommendation and the actual number of units ordered as well as the pre-transfusion Hgb/HCT results and the target Hgb/HCT selected in the order. Data was exported to spreadsheets for descriptive analysis.
Results/Findings: Seven years after implementation of the BUC, data for calendar year 2023 showed 7589 orders were reviewed. Of those, 7442 orders (98%) had an associated BUC recommendation. 87% of all orders accepted the BUC recommended RBC dose compared to 49% in the 24 months studied right after implementation. Of the remaining 13% of orders: 7% of orders were for fewer units than the BUC recommendation, 4% of orders were for more units than the BUC recommendation. In calendar year 2023, 84% of RBC orders were for 1 unit of blood and 14% of all RBC orders were for 2 units. The ratio of 1-unit to 2-unit transfusions was 6:1 compared to 1.7:1 24 months after starting the BUC. Conclusions: Five years after our initial report on the use of the BUC in our electronic medical record, the acceptance of the BUC recommendations for transfusion dose has increased by 40%. The high rates of acceptance of the BUC recommendation continued to increase the use of single unit transfusions with an ongoing and dramatic change in the ratio of 1-unit to 2-unit transfusions. Such changes improved institutional patient blood management.
