رسالة جامعية
Pediatric blood transfusions: Benchmarking tools for transfusions in surgical patients and the use of clinical decision support to optimize blood utilization
| العنوان: | Pediatric blood transfusions: Benchmarking tools for transfusions in surgical patients and the use of clinical decision support to optimize blood utilization |
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| المؤلفون: | Salazar Osuna, Jose H |
| المساهمون: | Tonascia, James, Segev, Dorry, Frank, Steven, Haut, Elliot |
| بيانات النشر: | Johns Hopkins University USA |
| سنة النشر: | 2019 |
| المجموعة: | Johns Hopkins University, Baltimore: JScholarship |
| مصطلحات موضوعية: | blood transfusion, clinical decision support, benchmarking, packed red blood cell, provider order entry |
| الوصف: | In recent years, the use of blood products has come under increased scrutiny in an effort to optimize the use of medical resources. We assembled a working group and developed a set of evidence based recommendations for red blood cell (RBC) transfusions at the Johns Hopkins Bloomberg Children’s Center (JHBCC). Before implementing the guidelines, we began our studies by using a national surgical dataset to develop regression models that allow for benchmarking of transfusion practices in surgical patients between hospitals (Chapter 1). We then characterized the allocation of RBC to specific high-risk surgeries and found that more than half of the transfusions in children’s surgery are associated to only two procedures: spinal fusion for arthrodesis and craniectomy for craniosynostosis (Chapter 2). Once our guidelines were finalized, we embedded them into a clinical decision support (CDS) logic within our computerized provider ordering system. This intervention reminded providers of the evidence-based guidelines when attempting to transfuse outside of recommended thresholds. We analyzed the effect of the CDS mechanism by comparing incidence rates of transfusion (Chapter 3). We used a zero-inflated negative binomial regression model to adjust for covariates while using historical controls. The CDS intervention was associated with a decrease of blood transfusions in patients >3 months of age (IRR 0.818, p<0.001) but not in patients <3 months (IRR 0.972, p=0.739). The ascertainment of pre and post-transfusion hemoglobin values during the year of the intervention allowed us to investigate adherence to the newly created JHBCC guidelines (Chapter 4). From 1955 transfusions, 41.6% were compliant with institutional recommendations (46.7% in patients <3 months and 35.1% in patients >3 months). Lastly, we studied the different approaches that hospital units have in relation to volume of RBC ordered. While there are differences in comorbidity profiles of patients between hospitals units, we found that similar ... |
| نوع الوثيقة: | thesis |
| وصف الملف: | application/pdf; application/vnd.openxmlformats-officedocument.wordprocessingml.document |
| اللغة: | English |
| العلاقة: | http://jhir.library.jhu.edu/handle/1774.2/62060Test |
| الإتاحة: | http://jhir.library.jhu.edu/handle/1774.2/62060Test |
| رقم الانضمام: | edsbas.A2AEF31E |
| قاعدة البيانات: | BASE |
| الوصف غير متاح. |