The appropriateness and physician compliance of platelet usage by a computerized transfusion decision support system in a medical center
The appropriateness and physician compliance of platelet usage by a computerized transfusion decision support system in a medical center
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DOI：
10.1111/j.1537-2995.2010.02757.x
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发表时间：
2010-12-01
期刊：
影响因子：
2.9
通讯作者：
Wu, Yung-Chao
中科院分区：
文献类型：
--
作者：
Lin, Yi-Ching;Chang, Chao-Sung;Wu, Yung-Chao
背景：不适当的血小板（PLT）输注处方一直是一个重要的问题。自2004年9月起，高雄医学大学附属医院已使用电脑化输血决策支援系统（CTDSS）。在这项研究中，医生的依从性和适当的PLT使用后，使用CTDSS进行了调查。研究设计和方法：共5887 PLT输血事件之间的2008年1月至12月进行了审查，包括人口统计学数据和“真正的原因”，为每个输血的做法。检索输血前和输血后的PLT计数。结果：医生依从性为85.4%，血小板使用的适当性为69.6%。CTDSS中最常选择的适应症是“预防性使用，PLT计数< 20 x 109/L。“最高的不适当订单率来自急诊科。超过一半的不当事件来自外科。不同订单来源和功能单位的不恰当率差异有统计学意义（p < 0.0001）。三分之二的病例输血后血小板计数增加，其中大部分病例输血前血小板计数低于50 × 109/L。结论：在台湾，血小板浓度太低，这可能会导致血液成分的过度使用。在全民健康保险的整体预算下，防止血液成分的过度使用可能是改善医疗质量的机制之一。CTDSS应更有力、更有效地干预输血实践的适当性。
BACKGROUND:The prescribing of inappropriate platelet (PLT) transfusions is always a significant problem. A computerized transfusion decision support system (CTDSS) has been used in Kaohsiung Medical University Hospital since September 2004. In this study, the physician compliance and appropriateness of PLT usage after using the CTDSS were investigated.STUDY DESIGN AND METHODS:A total of 5887 PLT transfusion episodes between January and December 2008 were reviewed including the demographic data and the "true reason" for each transfusion practice. The pre- and posttransfusion PLT counts were retrieved. The physician compliance, the appropriateness of PLT usage, and the PLT increments after transfusion were investigated.RESULTS:Physician compliance was 85.4%, and the appropriateness of PLT usage was 69.6%. The most commonly chosen indication from the CTDSS was "prophylactic use, PLT count < 20 x 109/L." The highest inappropriate order rate was from the emergency department. More than half of the inappropriate episodes were from the surgery unit. The inappropriate rates were significant in terms of both different order sources and functional units (p < 0.0001). The posttransfusion PLT counts increased in two-thirds of the episodes, and most of them were with the pretransfusion PLT counts of less than 50 x 109/L.CONCLUSIONS:In Taiwan, the PLT concentration is too low-priced and this might cause the overuse of blood components. Under the global budget of National Health Insurance, preventing the overuse of blood components might serve as one of the mechanism to improve medical quality. The CTDSS should be more powerful and effective to intervene in the appropriateness of transfusion practice.