Trends in RBC Ordering and Use After Implementing Adaptive Alerts in the Electronic Computerized Physician Order Entry System

Abstract

OBJECTIVES: To reduce unnecessary RBC transfusions, the computerized physician order entry (CPOE) system was programmed to require prescribers to select an indication for transfusion. An alert appeared if the patient's hemoglobin (Hb) level was above the threshold determined by the selected indication (adaptive alerts). METHODS: Data on RBC orders from the 4 months before the adaptive alerts were implemented were compared with the 10 months after implementation. RESULTS: Significantly fewer alerts were generated after the implementation, and the rate at which the alerts were heeded also increased. There was a trend toward fewer RBC units transfused after adaptive alert implementation. A large number of RBCs were ordered using a nonspecific transfusion indication, although many of these patients had antecedent Hb values close to the threshold. CONCLUSIONS: Electronically generated alerts can reduce but are insufficient to eliminate non-evidence-based transfusions. Analysis of the alerts suggests areas for CPOE improvement.