Effects of a Platelet Transfusion Best Practices Alert

Thrombocytopenia Clinical Trial

Official title:

Effects of a Platelet Transfusion Best Practices Alert

Clinical Trial Details — Status: Completed

Administrative data

• NCT number: NCT04155775
• Other study ID #: IRB-47797
• Status: Completed
• Phase: N/A
• Start date: May 9, 2019
• Est. completion date: February 4, 2020

Study information

• Verified date: February 2023
• Source: Stanford University
• Contact: n/a
• Is FDA regulated: No
• Study type: Interventional

Clinical Trial 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).

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.

Recruitment information / eligibility

• Status: Completed
• Enrollment: 446
• Est. completion date: February 4, 2020
• Est. primary completion date: February 4, 2020
• Accepts healthy volunteers: No
• Gender: All
• Age group: N/A and older

Eligibility

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

Related Conditions & MeSH terms

• Thrombocytopenia

Intervention

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.

Locations

Country	Name	City	State
United States	Stanford Healthcare	Stanford	California

Sponsors (1)

Lead Sponsor	Collaborator
Stanford University

Country where clinical trial is conducted

United States, 

References & Publications (1)

Murphy C, Mou E, Pang E, Shieh L, Hom J, Shah N. A randomized study of a best practice alert for platelet transfusions. Vox Sang. 2022 Jan;117(1):87-93. doi: 10.1111/vox.13132. Epub 2021 Jun 3. — View Citation

Outcome

Type	Measure	Description	Time frame	Safety issue
Primary	Platelet transfusions above threshold	Number of platelet transfusions occurring in patients with recent platelet counts above 50k/uL	Data will be initially reviewed before 6 months from start with anticipated completion 1 year from start
Secondary	Total platelet transfusions	Total number of platelet transfusions occurring during study period.	Data will be initially reviewed before 6 months from start with anticipated completion 1 year from start