Effects of a Platelet Transfusion Best Practices Alert

Not Applicable

Completed

• Conditions: Thrombocytopenia
• Interventions: Other: Computer electronic health record alert (Best Practice Alert - BPA)

• Registration Number: NCT04155775
• Lead Sponsor: Stanford University

Brief Summary

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

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.

Study Timeline

• Study Start: 2019-05-09
• Study First Submitted: 2019-05-15
• Study First Submitted QC: 2019-11-05
• Study First Posted: 2019-11-07
• Primary Completion: 2020-02-04
• Study Completion: 2020-02-04
• Status Verified: 2023-02
• Last Update Submitted: 2023-02-07
• Last Update Posted: 2023-02-09

Recruitment & Eligibility

• Status: COMPLETED
• Sex: All
• Target Recruitment: 446

Inclusion Criteria

• Recent platelet count >50k/uL
• Platelet transfusion ordered

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Exclusion Criteria

• Neurosurgery
• Procedure area (OR, catheterization lab, interventional radiology suite)
• Documented history of antiplatelet agent

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Study & Design

• Study Type: INTERVENTIONAL
• Study Design: PARALLEL

Arm && Interventions

Group	Intervention	Description
Best Practice Alert	Computer electronic health record alert (Best Practice Alert - BPA)	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.

Primary Outcome Measures

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

Secondary Outcome Measures

Name	Time	Method
Total platelet transfusions	Data will be initially reviewed before 6 months from start with anticipated completion 1 year from start	Total number of platelet transfusions occurring during study period.

Trial Locations

Locations (1)

Stanford Healthcare; 🇺🇸 Stanford, California, United States