Economic value of clinical decision support allied to direct data feedback to clinicians: blood usage in haematology

Abstract

Responding to national and local pressures to reduce the amount of blood transfused, the haematology department of Oxford University Hospitals (OUH), UK implemented an electronic blood-ordering system with clinical decision support. This intervention targeted junior doctors, giving regular feedback on their transfusion practices with respect to clinical guidelines. We evaluated the incremental costs of the intervention using interrupted time series methods to compare red blood cell and platelet usage before and after the intervention was implemented. Difference-in-differences analysis was used to control for external factors that would affect the use of blood products over time. Reductions in blood usage were balanced against intervention costs. The base case analysis showed an average cost saving to the department of £89304 annually as a result of the intervention. Scenario analyses suggested that the savings may have been greater still, had the increasing trend in blood use prior to the intervention continued in the absence of the intervention. An electronic blood-ordering system with clinical decision support can reduce blood transfusions and associated healthcare costs. Focusing on improving junior doctors' transfusion practice is expected to have a knock-on benefit in terms of dissemination of good transfusion practice both within their own department and others as they continue their training.