Restrictive blood transfusion practices are associated with improved patient outcomes

Background Blood transfusion has been cited as one of the five most overutilized therapeutic procedures in the United States. We assessed the impact of clinical decision support at computerized physician order entry and education on red blood cell (RBC) transfusions and clinical patient outcomes at our institution. Study Design and Methods Clinical patient outcomes and RBC transfusions were assessed before and after implementation of a best practice alert triggered for transfusions when the hemoglobin level was higher than 7 g/dL for all inpatient discharges from January 2008 through December 2013. Retrospective clinical and laboratory data related to RBC transfusions were extracted: case‐mix complexity, patient discharges and selected surgical volumes, and patient outcomes (mortality, 30‐day readmissions, length of stay). Results There was a significant improvement in RBC utilization as assessed by RBC units transfused per 100 patient‐days‐at‐risk. Concurrently, hospital‐wide clinical patient outcomes showed improvement (mortality, p = 0.034; length of stay, p = 0.003) or remained stable (30‐day readmission rates, p = 0.909). Outcome improvements were even more pronounced in patients who received blood transfusions, with decreased mortality rate (55.2 to 33.0, p