Effects of a Platelet Transfusion Best Practices Alert

Overview

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).

Study Type

  • Study Type: Interventional
  • Study Design
    • Allocation: Randomized
    • Intervention Model: Parallel Assignment
    • Primary Purpose: Other
    • Masking: None (Open Label)
  • Study Primary Completion Date: February 4, 2020

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

  • Other: Computer 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.

Arms, Groups and Cohorts

  • Experimental: Best Practice Alert
    • Platelet transfusion orders for patients with a recent platelet count exceeding 50,000 per microliter (50k/uL) will trigger an alert in the electronic health record that displays current guidelines for platelet transfusion. The alert will allow providers to bypass the recommendation and continue with platelet ordering by selecting a clinical acknowledgement / exception to recommendation.Exclusions will be built into the alert to avoid triggering in operative or procedural settings, for neurosurgery providers, or patients on anti-platelet medications.
  • No Intervention: No Best Practice Alert
    • For this group, no visible best practice alert will activate in the electronic health record for platelet transfusion orders and recent counts above 50k/uL.

Clinical Trial Outcome Measures

Primary Measures

  • Platelet transfusions above threshold
    • Time Frame: 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 Measures

  • Total platelet transfusions
    • Time Frame: 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.

Participating in This Clinical Trial

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

Gender Eligibility: All

Minimum Age: N/A

Maximum Age: N/A

Are Healthy Volunteers Accepted: No

Investigator Details

  • Lead Sponsor
    • Stanford University
  • Provider of Information About this Clinical Study
    • Sponsor
  • Overall Official(s)
    • Colin H Murphy, MD, Principal Investigator, Stanford University
    • Neil Shah, MD, Principal Investigator, Stanford University

Citations Reporting on Results

Murphy C, Mou E, Pang E, Shieh L, Hom J, Shah N. A randomized study of a best practice alert for platelet transfusions. Vox Sang. 2022 Jan;117(1):87-93. doi: 10.1111/vox.13132. Epub 2021 Jun 3.

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