Effects of a Platelet Transfusion Best Practices Alert

Study Overview
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Brief Summary
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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).

Detailed Description
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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.

Official Title
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Effects of a Platelet Transfusion Best Practices Alert

Conditions
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Thrombocytopenia

Intervention / Treatment
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* Other: Computer electronic health record alert (Best Practice Alert - BPA)


Participation Criteria
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Eligibility Criteria
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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
Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Other
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Best Practice Alert<br>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. | Other: Computer electronic health record alert (Best Practice Alert - BPA)<br>* 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.<br>|
| No Intervention: No Best Practice Alert<br>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. | |

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Platelet transfusions above threshold | Number of platelet transfusions occurring in patients with recent platelet counts above 50k/uL | Data will be initially reviewed before 6 months from start with anticipated completion 1 year from start | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Total platelet transfusions | Total number of platelet transfusions occurring during study period. | Data will be initially reviewed before 6 months from start with anticipated completion 1 year from start | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Electronic Health Records, Best Practice Alerts