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Effects of a Platelet Transfusion Best Practices Alert

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ClinicalTrials.gov Identifier: NCT04155775
Recruitment Status : Enrolling by invitation
First Posted : November 7, 2019
Last Update Posted : November 7, 2019
Sponsor:
Information provided by (Responsible Party):
Neil Shah, Stanford University

Brief 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).

Condition or disease Intervention/treatment
Thrombocytopenia Other: Computer electronic health record alert (Best Practice Alert - BPA)

Detailed 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.

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Study Type : Observational
Estimated Enrollment : 200 participants
Observational Model: Case-Control
Time Perspective: Prospective
Official Title: Effects of a Platelet Transfusion Best Practices Alert
Actual Study Start Date : May 15, 2019
Estimated Primary Completion Date : December 31, 2019
Estimated Study Completion Date : June 30, 2020

Resource links provided by the National Library of Medicine


Group/Cohort Intervention/treatment
Best Practice Alert
Platelet transfusion orders for patients with a recent platelet count exceeding 50,000 per microliter (50k/uL) will trigger an alert in the electronic health record that displays current guidelines for platelet transfusion. The alert will allow providers to bypass the recommendation and continue with platelet ordering by selecting a clinical acknowledgement / exception to recommendation.Exclusions will be built into the alert to avoid triggering in operative or procedural settings, for neurosurgery providers, or patients on anti-platelet medications.
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.

No Best Practice Alert
For this group, no visible best practice alert will activate in the electronic health record for platelet transfusion orders and recent counts above 50k/uL.



Primary Outcome Measures :
  1. Platelet transfusions above threshold [ Time Frame: Data will be initially reviewed before 6 months from start with anticipated completion 1 year from start ]
    Number of platelet transfusions occurring in patients with recent platelet counts above 50k/uL


Secondary Outcome Measures :
  1. Total platelet transfusions [ Time Frame: Data will be initially reviewed before 6 months from start with anticipated completion 1 year from start ]
    Total number of platelet transfusions occurring during study period.



Information from the National Library of Medicine

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Ages Eligible for Study:   Child, Adult, Older Adult
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   No
Sampling Method:   Probability Sample
Study Population
All patients receiving platelet transfusions with platelet counts >50k/uL outside of special exclusion and procedure areas.
Criteria

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

Information from the National Library of Medicine

To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.

Please refer to this study by its ClinicalTrials.gov identifier (NCT number): NCT04155775


Locations
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United States, California
Stanford Healthcare
Stanford, California, United States, 94305-5626
Sponsors and Collaborators
Stanford University
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Responsible Party: Neil Shah, Clinical Associate Professor, Medical Informatics Director, Stanford University
ClinicalTrials.gov Identifier: NCT04155775    
Other Study ID Numbers: IRB-47797
First Posted: November 7, 2019    Key Record Dates
Last Update Posted: November 7, 2019
Last Verified: November 2019
Individual Participant Data (IPD) Sharing Statement:
Plan to Share IPD: No

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Studies a U.S. FDA-regulated Drug Product: No
Studies a U.S. FDA-regulated Device Product: No
Keywords provided by Neil Shah, Stanford University:
Electronic Health Records
Best Practice Alerts
Additional relevant MeSH terms:
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Thrombocytopenia
Blood Platelet Disorders
Hematologic Diseases