IMPROVING THE ACCURACY OF TRANSFUSION DECISION MAKING

这是一个正在进行的项目(HS05300)的更新，旨在 提高血液检测的临床准确性和成本效益 产品输液。在第一阶段，大规模审计 16家医院发现红细胞(RBC)和新鲜血液比例较高 不符合以下标准的冷冻血浆(FFP)输注 临床适宜性。一个基于计算机的审计工具是 在分层随机抽样的医院中设计和使用 扫描大量输液以确定是否合适 效率。确定哪些剧集的各种算法 因此，可以在选定记录被 已提交以供隐含医生审查。同样在第一阶段，一个 医生对血液制品使用的信念和态度调查 被创建和管理。这些组件奠定了基础 全面的教育干预，这将是 在当前项目中以对照试验方式实施。医疗 教学和社区医院的外科服务将是 随机分为实验组和对照组。评估后 基准实践和信念的基础上，试验性服务将 在综合考虑以下因素的情况下， 组件：面对面教育、反馈、基于印刷的 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；持续的审计程序 将被用来衡量计划的效果。收益和成本将 从临床和经济两方面进行计算。除了……之外 提供对优化管理的洞察力，并日益 在血液供应受限的情况下，这项研究将提供经验和 提高临床决策水平的理论思考 急救技术也是如此。

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.