Creation of a Dynamic, Centralized Resource of Blood Product Transfusion Documentation in the Electronic Health Record to Promote High Value Care

From the 2021 HVPAA National Conference

Joseph Goldenberg (University of Chicago), Mary Acosta, Eve Edstrom, Shannon Martin, Vineet Arora, Micah Prochaska

Background

Accurate documentation of blood product transfusion is critical to avoid unnecessary transfusion, to ensure compliance with regulatory requirements of the Joint Commission and the FDA, and to allow for accurate data capture for research and/or quality improvement purposes. However, Electronic Health Records (EHRs) often lack both a centralized location and the informatics infrastructure for providers to reliably track blood product transfusions, which could result in adverse events and patient harm.

Objective

Determine from a diverse set of stakeholders across clinical disciplines their needs for tracking transfusions in hospitalized patients, and then build an easily accessible dashboard in the EHR informatics architecture that addresses those needs and captures the appropriate data.

Methods

As part of the Choosing Wisely(™) Challenge at University of Chicago, an interdisciplinary task force was assembled, comprising nurses, residents, hospital administrators, blood bank pathologists, clinical hospitalists and researchers, and surgeons. We created a hospital-wide survey to assess overall provider satisfaction with current transfusion documentation prior to our interventions. EHR information technologists at our University hospital assisted with implementing changes to blood transfusion documentation.

Results

The survey was completed by a total of 265 providers including nurses, advanced practice providers, residents, and attendings across 30 subspecialties. The majority of respondents, over 82%, were dissatisfied with our current documentation record. In questions about transfusion records, 73% found our current documentation difficult to locate, 40% unsure how to determine the type of product transfused, and 60% unsure how to determine the number of products transfused. About 65% of providers reported they believe the current documentation record has led to patient safety issues, with 26% reporting they had missed transfusion reactions, and 38% reporting having ordered additional blood products due to current transfusion reaction documentation. In response to survey feedback, our team created a new page in our EHR that contains relevant background patient information, such as type-and-screen, a running cumulative total of transfusions through different time periods, such as past 12 hours and the entire admission, and a real-time view of each transfusion overlaid with the most recent CBC and coagulation studies.

Conclusions

The majority of providers at our institution found blood transfusion documentation to be cumbersome, irrespective of specialty and healthcare team role. Nearly two-thirds believed current documentation shortcomings had contributed to patient harm. While not a majority, a notable number of providers felt they missed transfusion reactions and ordered additional blood products. A single location, accessible with one mouse-click, was created containing the number of blood transfusions received by the patient and real-time lab testing including CBC and coagulation data. Future work will evaluate the impact of this dashboard on utilization and satisfaction.

Clinical Implications

We sought to increase safety of blood product transfusions at University of Chicago and increase awareness of transfusion reactions through improving transfusion documentation by creation of a single, centralized location within our EHR.