Stanford University
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.
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.
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.
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