Abstract

Background Blood transfusion has been cited as one of the five most overutilized therapeutic procedures in the U nited S tates. We assessed the impact of clinical decision support at computerized physician order entry and education on red blood cell ( RBC ) transfusions and clinical patient outcomes at our institution. Study Design and Methods Clinical patient outcomes and RBC transfusions were assessed before and after implementation of a best practice alert triggered for transfusions when the hemoglobin level was higher than 7 g/ dL for all inpatient discharges from J anuary 2008 through D ecember 2013. Retrospective clinical and laboratory data related to RBC transfusions were extracted: case‐mix complexity, patient discharges and selected surgical volumes, and patient outcomes (mortality, 30‐day readmissions, length of stay). Results There was a significant improvement in RBC utilization as assessed by RBC units transfused per 100 patient‐days‐at‐risk. Concurrently, hospital‐wide clinical patient outcomes showed improvement (mortality, p = 0.034; length of stay, p = 0.003) or remained stable (30‐day readmission rates, p = 0.909). Outcome improvements were even more pronounced in patients who received blood transfusions, with decreased mortality rate (55.2 to 33.0, p < 0.001), length of stay (mean, 10.1 to 6.2 days, p < 0.001), and 30‐day readmission rate (136.9 to 85.0, p < 0.001). The mean number of units transfused per patient also declined (3.6 to 2.7, p < 0.001). Acquisition costs of RBC units per 1000 patient discharges decreased from $283,130 in 2009 to $205,050 in 2013 with total estimated savings of $6.4 million and likely far greater impact on total transfusion‐related costs. Conclusion Improved blood utilization is associated with improved clinical patient outcomes.