Clinical Decision Support for Blood Transfusions to Improve Guideline Adherence

Study Overview
=================
Brief Summary
-----------------
Determine whether clinical decision support (best practice advisory) improves provider adherence to transfusion guidelines for all four major blood components (red blood cells, plasma, platelets, and cryoprecipitate) using a randomized study design to reduce risk of bias. Alerts will be visible to the experimental ordering provider group, while they will not be visible to the control. Both groups still have access to information about best practices: local clinical transfusion guidelines are available and education on blood transfusion best practices will continue regardless of randomization assignment.

Official Title
-----------------
Clinical Decision Support for Blood Transfusions to Improve Guideline Adherence

Conditions
-----------------
Anemia, Thrombocytopenia, Coagulopathy, Mild, Hypofibrinogenemia

Intervention / Treatment
-----------------
* Behavioral: Clinical Decision Support


Participation Criteria
=================
Eligibility Criteria
-----------------
Inclusion Criteria: - Ordering providers that order at least one blood product in the electronic health record Exclusion Criteria: Any individual without privileges to place an initial order for blood product(s)

Ages Eligible for Study
-----------------
Minimum Age: 18 Years

Sexes Eligible for Study
-----------------
All

Accepts Healthy Volunteers
-----------------
No

Study Plan
=================
How is the study designed?
-----------------

Design Details

Primary Purpose: Health Services Research
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Single


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Ordering Providers Assigned to Visible Clinical Decision Support Alerts<br>Clinical decision support alert will fire and become visible to the ordering provider in the electronic health record if blood product(s) are ordered out of accordance with guidelines. Information about transfusion guidelines and best practices will be sent to providers prior to starting the study and will be available on an internal website. | Behavioral: Clinical Decision Support<br>* In blood product order entry within the electronic health record, the ordering provider is required to select an indication for the blood product order. If the patient's laboratory values are not in line with the guideline indication selected, a clinical decision support alert will fire and be shown to the ordering provider. This alert will inform the provider that the order is outside institutional guidelines and the provider has the option to cancel the order (or bypass the order and select a reason for proceeding with the order).<br>* Other names: Best Practice Advisory;|
| No Intervention: Ordering Providers Assigned to No Visible Clinical Decision Support Alerts<br>Clinical decision support alert will not be visible to the ordering provider in the electronic health record if blood product(s) are ordered out of accordance with guidelines. Information about transfusion guidelines and best practices will be sent to providers prior to starting the study and will be available on an internal website. | |

What is the study measuring?
-----------------
Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Number of blood components transfused that met clinical decision support alert criteria | Number of blood components transfused (includes red blood cell, platelet, plasma, and cryoprecipitate pools) that met criteria for clinical decision support alerts to fire | Through study completion, an average of 12 months | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Number of red blood cell components transfused that met clinical decision support alert criteria | Number of red blood cell components transfused that met criteria for clinical decision support alerts to fire | Through study completion, an average of 12 months | 
| Number of platelet components transfused that met clinical decision support alert criteria | Number of platelet components transfused that met criteria for clinical decision support alerts to fire | Through study completion, an average of 12 months | 
| Number of plasma components transfused that met clinical decision support alert criteria | Number of plasma components transfused that met criteria for clinical decision support alerts to fire | Through study completion, an average of 12 months | 
| Number of cryoprecipitate component pools transfused that met clinical decision support alert criteria | Number of cryoprecipitate component pools transfused that met criteria for clinical decision support alerts to fire | Through study completion, an average of 12 months | 

 Terms related to the study
=================
Keywords Provided by Centre Hospitalier Valida
-----------------
Transfusion, Clinical Decision Support