Interruptive alert for Blood Transfusions

Phase-Based Estimates
1
Effectiveness
1
Safety
UCHealth University of Colorado Hospital, Aurora, CO
Interruptive alert - Behavioral
Eligibility
Any Age
All Sexes
Eligible conditions
Blood Transfusions

Study Summary

Blood Transfusion Reduction - QI Project

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Treatment Effectiveness

Study Objectives

This trial is evaluating whether Interruptive alert will improve 3 primary outcomes and 3 other outcomes in patients with Blood Transfusions. Measurement will happen over the course of Baseline.

52 weeks
Blood Transfusions
78 weeks
Blood Transfusion Orders
Guideline Concordance Measured by Pre-Transfusion Hemoglobin Values Per Transfusion
Baseline
Guideline Concordance Measured by Number of Units Ordered Per Transfusion
Historical Blood Transfusion Orders
Historical Guideline Concordance Measured by Pre-Transfusion Hemoglobin Values Per Transfusion

Trial Safety

Trial Design

3 Treatment Groups

No Control Group
In-line help text

This trial requires 1640 total participants across 3 different treatment groups

This trial involves 3 different treatments. Interruptive Alert is the primary treatment being studied. Participants will be divided into 3 treatment groups. There is no placebo group. The treatments being tested are not being studied for commercial purposes.

In-line help text
Behavioral
In addition to general improvement changes, subjects exposed to the in-line help text arm receive text detailing evidence-based transfusion recommendations that appear if the most recent hemoglobin level is above 7.0 g/dL. This text appears within the transfusion order but is non-interruptive as it does not require users to acknowledge the text nor does is require any additional keystrokes or clicks.
Interruptive alert
Behavioral
In addition to general improvement changes, subjects exposed to the interruptive alert arm receive text detailing evidence-based transfusion recommendations that appear if the most recent hemoglobin level is above 7.0 g/dL. In contrast to the in-line help text arm, this arm includes an interruptive alert that appears when the user selects the transfusion order. This alert offers users the option to remove the order which results in no-blood product ordered. Alternatively, users may continue to order blood and are asked to select the reason for proceeding with the intended order.
General improvement
Behavioral
Using the expertise of the study personnel, electronic-health record system architects working for UCHealth, and incorporating feedback from the users who participated in the user-centered design sessions we made changes to the blood transfusion order-set as well as the "prepare" and "transfuse" orders. The intention of the changes to the interface are to be more intuitive for ordering clinicians.

Trial Logistics

Trial Timeline

Approximate Timeline
Screening: ~3 weeks
Treatment: Varies
Reporting: 78 weeks
This trial has the following approximate timeline: 3 weeks for initial screening, variable treatment timelines, and roughly 78 weeks for reporting.

Closest Location

UCHealth University of Colorado Hospital - Aurora, CO

Eligibility Criteria

This trial is for patients born any sex of any age. There are 2 eligibility criteria to participate in this trial as listed below.

Mark “yes” if the following statements are true for you:
All healthcare professionals who have access to ordering inpatient blood transfusions through a hospital-based electronic medical record. show original
The physicians and nurses ordering blood for individuals over the age of 18 are required to complete a form that specifies the reason for the blood order. show original

Patient Q&A Section

Please Note: These questions and answers are submitted by anonymous patients, and have not been verified by our internal team.

What are the signs of blood transfusions?

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Many patients have abnormal signs, some of which may be fatal or serious. Anemia leads to fatigue and may complicate or cause an error to be made in the hospital. Signs of blood transfusions may include tachycardia or abnormality of heart rhythm, nausea, vomiting, loss of consciousness or weakness; they should be treated as if life-threatening.

Unverified Answer

How many people get blood transfusions a year in the United States?

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Blood transfusions are commonly performed among hospitalized patients and among hospitalized patients undergoing major noncardiac surgery. The estimated number of patients receiving more than 3 units of blood may be as high as 1 billion per year.

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Can blood transfusions be cured?

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Blood transfusions do not cure a patient with anemia or anemia due to blood loss during surgery. All patients with anemia may benefit, but some patients who may experience a temporary decrease in hemoglobin level or who have the more severe anemia may not benefit from a blood transfusion or the transfusion may have no effect. Patients who have undergone a blood transfusion should be carefully followed with anemia until treatment results are understood.

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What causes blood transfusions?

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Patients with unexplained anemia often have a blood transfusion prior to obtaining their lab test results. Appropriate blood management will reduce the need for blood transfusion without adversely impacting the patient's hematocrit.

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What are common treatments for blood transfusions?

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Blood is transfused for a number of reasons. To protect the patient from disease transmission requires a blood typing to help determine compatibility of compatible/incompatible blood groups. The risk of developing allergies from transfusions is not increased with allogeneic blood donations. Relevant aspects of platelet function are impaired during storage and it is possible to transfuse autologous blood.

Unverified Answer

What is blood transfusions?

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Blood transfusions are associated with a significant increase of morbidity and mortality in patients undergoing cardiac surgery. Performing blood transfusions is associated with the risk of a composite endpoint consisting of: all-cause mortality, septic complications, or bleeding related to transfusion, which is more than quadruple that of patients who did not receive transfusions. Blood transfusions are also associated with increased lengths of hospital and total ICU stay but not with a difference in length of ICU stay or hospital stay based on age.

Unverified Answer

How does interruptive alert work?

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Recent findings show that interruptive alerts provide clinicians with improved performance on clinical questions about transfusion reaction risks and transfusion efficacy and safety relative to other interventions. The benefit of interruptive alerts is not merely in improved performance of clinicians but is a result of the interruption of regular workflow of everyday clinical practice.

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Have there been other clinical trials involving interruptive alert?

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These authors found that interruptive alerting systems and the number of interruptions per capita were significantly lower in the trial group than in the control group. They conclude that interruptive alerting system is an effective way to detect medication-related adverse events in realtime.

Unverified Answer

Does blood transfusions run in families?

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The finding of a significant association between the presence of blood-group markers and the presence of alloantibodies in the serum of subjects with the disease and the occurrence of a transfused sibling as well as the presence of blood-group markers in the plasma of subjects with the disease, suggest that there may be a genetic predisposition to transfusion reactions in patients with the disease.

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What are the common side effects of interruptive alert?

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Most of the patients receiving interruptive alert experienced some side effects. The side effects could interfere with treatment. Inappropriate alert and interruptive alert will reduce the overall effect of treatment and cause anxiety for patients and their family members.

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What is the latest research for blood transfusions?

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Blood transfusions are an effective clinical approach for patients with anemia resulting from a wide range of causes. Despite widespread use in the health-care system, there remains a paucity of evidence from high-quality randomized controlled trials specifically addressing blood transfusions for anemia.

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What is interruptive alert?

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The effectiveness of these interruptive alert systems depends on all components of the system, as well as the specific setting in which they are applied. The effect of interruptive alert systems to reduce post transfusion hemoglobin is small. These warnings contribute to blood bank efficiency and may also reduce cost, though they have not been evaluated in other settings. Interruptive alert systems may contribute to patient fatigue and may negatively impact workload and patient satisfaction. The effectiveness of interruptive alerts may be reduced during high activity hours or when staff members are required to work long hours.

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