Implementation of Red Blood Cell Transfusion Recommendations in the Pediatric Intensive Care Unit

N/AEnrolling By InvitationNCT07108374

Stanford University200 enrolled

Overview

Evidence demonstrates that the risks of red blood cell transfusions outweigh benefits in many patients who are hospitalized in the pediatric intensive care unit with increased risk of organ dysfunction, infection, delirium, and death. Recommendations have been developed to restrict transfusion in patients who are unlikely to benefit; however, these recommendations have not been consistently adopted into clinical practice. This study examines use of targeted efforts (implementation strategies) to improve implementation of the recommendations, with a goal of reducing unnecessary transfusions and improving patient outcomes in critically ill children.

Study Type

INTERVENTIONAL

Allocation

Purpose

HEALTH_SERVICES_RESEARCH

Masking

NONE

Enrollment

200

Conditions

Red Blood Cell Transfusions

Interventions

Five implementation strategies will be employed in this study to enhance use of the blood transfusion recommendations. These include 1) building consensus, 2) provider education, 3) identifying and empowering champions ,4) use of computerized clinical decision support tools, and 5) provide quantitative metric-based feedback. Strategies 1-3 will occur prior to initiation of CCDS tools. All patients admitted to the PICU following the date of CCDS tool initiation will be considered to be part of the post-implementation phase. The investigators will collect data from the EHR on CCDS use and conduct provider surveys and interviews following CCDS tool initiation. Surveys and interviews will be both be conducted at 6 and 12 months post-CCDS tool initiation. Process and outcomes measures will be assessed before an after use of the implementation strategies.

Eligibility

Sex: ALL

Medical Language ↔ Plain English

Inclusion Criteria: * Employed at Lucile Packard Children's Hospital at Stanford University or the Children's Hospital of Philadelphia AND * Employed in one of the following roles: * PICU nurse * PICU attending * PICU fellow * PICU resident * PICU advanced practice provider * Other physician or surgeon in subspecialties whose patients regularly receive transfusions in the PICU * PICU TRIP implementation team member * PICU nursing leader * PICU physician leader * Bood bank leader. Exclusion Criteria: * Unwilling to participate * Directly report to the primary investigator.

Locations (2)

Lucile Packard Children's Hospital, Stanford University

Palo Alto, California, United States

The Children's Hospital of Philadelphia

Philadelphia, Pennsylvania, United States

Outcomes

Primary Outcomes

Mean change from baseline in transfusion recommendation adherence at 18 months (evidence-based threshold alert)

The investigators will assess the mean rate of nonadherent transfusions at monthly intervals in the pre- (12 months prior to CCDS tool initiation) and post-implementation period (18 months following CCDS tool initiation).

Time frame: 18 months

Secondary Outcomes

Mean change from baseline in transfusion recommendation adherence at 18 months (transfusions that require clinical judgement)

Time frame: 18 months

Reach of computerized clinical decision support (CCDS) tools

We will assess Reach of the CCDS tools by assessing the number of triggered CCDS alerts as compared with the total number of patients at risk for unnecessary transfusion (as determined through the PEDSnet database under IRB 16-012878, PEDSnet Master Secondary Use Protocol, under amendment 96, Appendix 28).

Time frame: 18 months