Praise for a method that implements the single-unit order!

Almost all over the world, the old doctrine in transfusion medicine that at least two units of packed red cells have to be given to an adult in need for transfusion while one unit is ineffective remains unquestioned. This strategy pays back by the doctor’s reassurance that the anaemia treatment will be of measurable effect. The method recommended in current guidelines ‒ to check the haemoglobin level following administration of a first unit, to reassess the indication and then to order a second unit, to wait until it arrives from the blood bank and then to administer it to the patient ‒ implies more work and a lengthy process. However, double-unit administration for patients who are not bleeding increases transfusion-associated risks and decreases blood availability for other recipients. Therefore, any method that achieves the avoidance of the double-unit pattern in clinical practice should be commended.

This study by McKinney et al. successfully used electronic guidance of clinical treatment decisions to reduce double-unit orders. Within three subsequent observation years, the clinical decision support software was able to decrease transfused units per day and double-unit transfusion by more than two-fold. The method to use electronic help in form of plausibility checks, queries, crosschecks, networking or simply clinical guidance to implement restrictive transfusion strategy in clinical practice was ineffective in all previous published attempts. The trick McKinney and coworkers used is to ease single-unit orders in comparison to double-unit orders.

So the message of this important study is that it is easy to change clinical practice by finding ways to ease guideline adherence, in this case by electronic support! Also to be considered, inexpensive software generates a lot of benefit for the patient and cost savings for the hospital!

– Thomas Frietsch