Effects of a Platelet Transfusion Best Practices Alert

Sponsor

Stanford University (Other)

Overall Status

Unknown status

CT.gov ID

NCT04155775

Collaborator

(none)

200

Enrollment

Location

13.5

Anticipated Duration (Months)

14.8

Patients Per Site Per Month

Study Details

Study Description

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).

Condition or Disease	Intervention/Treatment	Phase
Thrombocytopenia	Other: Computer electronic health record alert (Best Practice Alert - BPA)

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 Design

Study Type:

Observational

Anticipated Enrollment :

200 participants

Observational Model:

Case-Control

Time Perspective:

Prospective

Official Title:

Effects of a Platelet Transfusion Best Practices Alert

Actual Study Start Date :

May 15, 2019

Anticipated Primary Completion Date :

Dec 31, 2019

Anticipated Study Completion Date :

Jun 30, 2020

Arms and Interventions

Arm	Intervention/Treatment
Best Practice Alert 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.	Other: Computer electronic health record alert (Best Practice Alert - BPA) Upon ordering platelets in patients with recent platelet count >50,000, a pop-up within the electronic health system will recommend to not continue with transfuse product order and provide clinical exceptions to continue. Importantly, the alert does not trigger in operating areas, emergency medicine treatment areas, for certain specialties like neurosurgery or for massive transfusion orders.
No Best Practice Alert For this group, no visible best practice alert will activate in the electronic health record for platelet transfusion orders and recent counts above 50k/uL.

Arm

Intervention/Treatment

Best Practice Alert

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.

Other: Computer electronic health record alert (Best Practice Alert - BPA)

Upon ordering platelets in patients with recent platelet count >50,000, a pop-up within the electronic health system will recommend to not continue with transfuse product order and provide clinical exceptions to continue. Importantly, the alert does not trigger in operating areas, emergency medicine treatment areas, for certain specialties like neurosurgery or for massive transfusion orders.

No Best Practice Alert

For this group, no visible best practice alert will activate in the electronic health record for platelet transfusion orders and recent counts above 50k/uL.

Outcome Measures

Primary Outcome Measures

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

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.

Eligibility Criteria

Criteria

Ages Eligible for Study:

N/A and Older

Sexes Eligible for Study:

All

Accepts Healthy Volunteers:

Inclusion Criteria:

Recent platelet count >50k/uL
Platelet transfusion ordered

Exclusion Criteria:

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

Contacts and Locations

Locations

	Site	City	State	Country	Postal Code
1	Stanford Healthcare	Stanford	California	United States	94305-5626

Sponsors and Collaborators

Stanford University

Investigators

None specified.

Study Documents (Full-Text)

None provided.

More Information

Publications

None provided.

Responsible Party:

Neil Shah, Clinical Associate Professor, Medical Informatics Director, Stanford University

ClinicalTrials.gov Identifier:

NCT04155775

Other Study ID Numbers:

IRB-47797

First Posted:

Nov 7, 2019

Last Update Posted:

Nov 7, 2019

Last Verified:

Nov 1, 2019

Individual Participant Data (IPD) Sharing Statement:

Plan to Share IPD:

Studies a U.S. FDA-regulated Drug Product:

Studies a U.S. FDA-regulated Device Product:

Keywords provided by Neil Shah, Clinical Associate Professor, Medical Informatics Director, Stanford University

Electronic Health Records

Best Practice Alerts

Additional relevant MeSH terms:

Thrombocytopenia

Study Results

No Results Posted as of Nov 7, 2019