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Electronic Medical Record Provides Dartmouth-Hitchcock Pathologists Powerful Tool to Push Best Practices in Transfusions

January 15, 2015
Lebanon, NH

By implementing a "best practice alert" function in the electronic medical record, pathologists at Dartmouth-Hitchcock, led by Nancy M. Dunbar, MD, significantly reduced physicians' orders for two-unit transfusions for non-bleeding patients. This program, published in Transfusion, caused physicians ordering transfusions to comply with evidence-based best practices except in unusual circumstances.

"We figured out how to harness the power of the electronic medical record to embed evidence-based transfusion criteria into the computerized physician order entry process through the best practices alert functionality," Dunbar explained.

New guidelines were the impetus for Dunbar and colleagues to review their transfusion practices, where they found not all providers were following evidence-based guidelines. Dunbar notes that, at large academic medical centers, it can be difficult to disseminate information to providers and education efforts may only result in temporary changes. By using the electronic medical record to inform physicians of best practices at the time of each transfusion order, the pathologists provided real-time education and reminders at the moment of each order. Study results show the proportion of two-unit transfusions decreased in the period after the implementation of the electronic best practices alert from 47 percent to 15 percent.

"This project in transfusion practice highlights the potential for information technology to potentially improve the quality of medical care in many other sites at our institution," said Dunbar.

The collaborators continue to monitor provider transfusion practices, and provide targeted near-time education to those that may continue to practice outside of evidence-based criteria. They also partner with clinicians to identify scenarios where the transfusion criteria may need to be modified based on evolving evidence.

"Best practices in transfusion medicine are updated continuously and it is our role in pathology to adopt the changes for our institution and spread the word," Dunbar said." The electronic medical record has proved to be the ideal way to get information about those changes to clinicians at just the time they need it."

Dunbar and her collaborators are from the departments of Pathology and Medicine at Dartmouth-Hitchcock Medical Center in Lebanon, NH. Swaroopa Yerrabothala is a hematology-oncology fellow at Dartmouth-Hitchcock's Norris Cotton Cancer Center.

About Norris Cotton Cancer Center at Dartmouth-Hitchcock

Norris Cotton Cancer Center combines advanced cancer research at Dartmouth and the Geisel School of Medicine with patient-centered cancer care provided at Dartmouth-Hitchcock Medical Center, at Dartmouth-Hitchcock regional locations in Manchester, Nashua, and Keene, NH, and St. Johnsbury, VT, and at 12 partner hospitals throughout New Hampshire and Vermont. It is one of 41 centers nationwide to earn the National Cancer Institute's "Comprehensive Cancer Center" designation. Learn more about Norris Cotton Cancer Center research, programs, and clinical trials online at cancer.dartmouth.edu.

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