IMPROVING THE ACCURACY OF TRANSFUSION DECISION MAKING

这是正在进行的项目（HS 05300）的更新，旨在 提高临床血液的准确性和成本效益 产品输血。 在第一阶段，大规模审计 16家医院显示红细胞（RBC）和新鲜 不符合以下标准的冷冻血浆（FFP）输注 临床适当性。 一个基于计算机的审计工具， 设计并用于医院的分层随机抽样， 扫描大量输血的适当性， 效率 各种算法来确定哪些情节 因此，可以在选定的记录被 提交给隐式医生审查。 在第一阶段， 医生对血液制品使用的信念和态度调查 创建并管理。 这些组成部分奠定了基础 进行全面的教育干预， 在当前项目的对照试验中实施。 医疗 教学医院和社区医院的外科服务将 随机分为实验组和对照组。 经评估后 基线实践和信念，实验服务将是 综合干预措施， 组成部分：面对面的教育，反馈，印刷 材料和订单提醒。 一种改进的交叉设计 将采用时间序列分析;持续审计程序 将被用来衡量计划的效果。 收益和成本将 从临床和经济两个方面来计算。 除了 提供对最佳管理的洞察， 限制血液供应，研究将摆脱经验和 提高临床决策水平的理论思考 还有急救技术

This is a renewal of an ongoing project (HS05300) designed to improve the clinical accuracy and cost-effectiveness of blood product transfusions. In the first phase, a large-scale audit of 16 hospitals revealed a high proportion of red cell (RBC) and fresh frozen plasma (FFP) transfusions which did not meet criteria of clinical appropriateness. A computer-based audit instrument was designed and used in a stratified random sample of hospitals to scan large numbers of transfusions for appropriateness with efficiency. A variety of algorithms for determining which episodes are flagged can thus be modeled before selected records are submitted for implicit physician review. Also in phase one, a survey of physician beliefs and attitudes about blood product use was created and administered. These components laid the groundwork for a comprehensive educational intervention which will be implemented in a controlled trial in the current project. Medical and surgical services in teaching and community hospitals will be randomized into experimental and control groups. After assessment of baseline practices and beliefs, experimental services will be given a comprehensive intervention combining the following components: face-to-face education, feedback, print-based materials, and order-form reminders. A modified crossover design with time-series analysis will be applied; ongoing audit procedures will be used to measure program effects. Benefits and costs will be calculated in both clinical and economic terms. In addition to providing insight into optimal management of and increasingly constrained blood supply, the research will shed empirical and theoretical light on improving clinical decisionmaking regard other acute-care technologies as well.