Clinical Pathology Selected Abstracts, 5/14

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Clinical pathology abstracts editor: Deborah Sesok-Pizzini, MD, MBA, associate professor, Department of Pathology and Laboratory Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, and medical director, Blood Bank and Transfusion Medicine, Children’s Hospital of Philadelphia.

Real-time clinical decision support systems for platelet and cryoprecipitate orders

Platelet and cryoprecipitate transfusions are often used to treat patients who are bleeding. However, many clinicians use non-evidence–based approaches to ordering and transfusing these products. Cost and such adverse effects as transfusion-transmitted diseases and transfusion reactions make it desirable to reduce the unnecessary transfusion of these products. The authors conducted a study in which they evaluated cryoprecipitate and platelet ordering practices after implementing real-time clinical decision-support systems in a computerized physician order-entry (CPOE) system. They implemented a uniform platelet and cryoprecipitate transfusion threshold at 11 hospitals in a regional health care system supported by the same CPOE system. The investigators collected data on the ordering physicians and the number of alerts generated by the clinical decision-support systems when orders were outside acceptable institutional guidelines. The results showed that of 1,889 platelet and 152 cryoprecipitate orders placed in six months, 58.3 percent and 48.7 percent triggered an alert, respectively. Transfusion orders that were cancelled after the alert ranged from 13.5 percent to 17 percent for platelets and zero to 50 percent for cryoprecipitates. The authors concluded that clinical decision-support system alerts reduce, but do not eliminate, platelet and cryoprecipitate transfusions that do not meet institutional guidelines. Many clinicians continued to order platelet and cryoprecipitate transfusions based on criteria that were not evidence based.

Collins RA, Triulzi DJ, Waters JH, et al. Evaluation of real-time clinical decision support systems for platelet and cryoprecipitate orders. Am J Clin Pathol. 2014;141:78–84.

Correspondence: Dr. Mark Yazer at myazer@itxm.org