Enhancing Compliance to Massive Hemorrhage Protocol through Clinical Decision Support Tool for Thromboelastography Interpretation

Background

Englewood Health (EH) has adopted innovative approaches to Patient Blood Management (PBM) over the past 25 years, prioritizing Patient Blood Management techniques to enhance patient outcomes [1]. Implementing a massive hemorrhage protocol (MHP) based on thromboelastography (TEG) to tailor treatment of coagulopathy allows goal-directed blood product transfusion. TEG-assisted transfusion, widely used in liver transplantation, cardiac surgery, and trauma, has demonstrated a reduction in blood product use by up to 50% [2]. However, its application outside the operating room (OR) has been limited. Challenges in hospital guideline compliance due to unfamiliarity and difficulty with TEG interpretation have led to underutilization of viscoelastic tests. Simplifying viscoelastic interpretation through a decision support tool can aid physicians in treatment strategies. Tools like AvoMD, a clinical decision support (CDS) tool, help enhance compliance by providing structured guidance on TEG interpretation.

Methods

In 2023, EH decided to expand TEG for institution-wide viscoelastic testing. EH collaborated with AvoMD to integrate its customized MHP into a TEG interpretation interface, allowing clinicians to input key metrics and receive real-time treatment recommendations. Retrospective analysis compared the annual number of rotational thromboelastometry (ROTEM), previously used at EH prior to AvoMD implementation, with the number of TEG tests ordered after.

Results

Since implementation of AvoMD, the number of viscoelastic tests ordered surged by 168%. From 2020 to 2022, an average of 83 tests were ordered annually, increasing to 223 tests per year from 2023 to 2024 following AvoMD integration.

Conclusion

Recommendations for treatment of ongoing bleeding are to provide goal-directed therapy to treat the underlying issue. TEG allows physicians to assess coagulation in real time and tailor blood product administration, decreasing costs and improving patient outcomes [3,4,5]; however, viscoelastic testing use outside the cardiac OR was minimal due to clinician unfamiliarity and infrequent use.

CDS systems integrate patient information with a knowledge base to improve guideline adherence and ultimately, patient safety [6, 9]. AvoMD is a platform designed to streamline clinical decision-making by simplifying evidence-based guidelines. The TEG interpretation interface not only increased the number of viscoelastic tests ordered but also empowered physicians by providing evidence-based recommendations at point of care.

The integration of EH's PBM protocols into workflow through the AvoMD platform represents a significant advancement in the quality of patient care. This project highlights the potential of emerging technology, such as the integration of CDS platforms into electronic medical records, to enhance protocol compliance and improve patient safety [7,8].

No relevant conflicts of interest to declare.