Abstract：
OBJECTIVE: To present a new method for displaying blood utilization data based on analysis of decision time intervals (DTIs).
METHODS: Retrospective study of patients treated in a medical intensive care unit (ICU), surgical ICU, or postcardiac surgery ICU at an academic hospital between January 2018 and June 2023. Each patient\'s episode of care was divided into a series of DTIs. Transfusions during each time interval were recorded.
RESULTS: In total, 16,562 patients received 6980 units of plasma and 21,034 units of red blood cells during 111,557 time intervals of care. Patients had international normalized ratio (INR) values ranging from less than 1.0 to more than 4.0. Data on plasma transfusion at different INR values were displayed as the number of transfusion episodes, number of units given, or the proportion of DTIs with transfusion. Clinicians transfused plasma on 1.5% of occasions when the INR was 1.5 or less and on 2.2% of occasions when the INR was less than 2.0. Plasma was transfused without red blood cells in only 0.75% of DTIs. Transfusion practice was statistically different among the 3 ICUs.
CONCLUSIONS: Compared with traditional methods of displaying the results of blood audits, DTI analysis displays information regarding the decision both to transfuse and to not transfuse. Utilization reviews that display data based on decision time analysis reveal clinical practice patterns very different from those suggested by traditional displays of plasma audit data.
METHODS: Retrospective study of patients treated in a medical intensive care unit (ICU), surgical ICU, or postcardiac surgery ICU at an academic hospital between January 2018 and June 2023. Each patient\'s episode of care was divided into a series of DTIs. Transfusions during each time interval were recorded.
RESULTS: In total, 16,562 patients received 6980 units of plasma and 21,034 units of red blood cells during 111,557 time intervals of care. Patients had international normalized ratio (INR) values ranging from less than 1.0 to more than 4.0. Data on plasma transfusion at different INR values were displayed as the number of transfusion episodes, number of units given, or the proportion of DTIs with transfusion. Clinicians transfused plasma on 1.5% of occasions when the INR was 1.5 or less and on 2.2% of occasions when the INR was less than 2.0. Plasma was transfused without red blood cells in only 0.75% of DTIs. Transfusion practice was statistically different among the 3 ICUs.
CONCLUSIONS: Compared with traditional methods of displaying the results of blood audits, DTI analysis displays information regarding the decision both to transfuse and to not transfuse. Utilization reviews that display data based on decision time analysis reveal clinical practice patterns very different from those suggested by traditional displays of plasma audit data.
摘要：
目的：提出一种基于决策时间间隔（DTI）分析的显示血液利用数据的新方法。
方法：在重症监护病房（ICU）接受治疗的患者的回顾性研究，外科ICU,或2018年1月至2023年6月期间在一家学术医院进行心脏手术后ICU。每个患者的护理事件被分为一系列DTI。记录每个时间间隔期间的输血。
结果：总计，在111,557个时间间隔的护理中，有16,562名患者接受了6980单位的血浆和21,034单位的红细胞。患者的国际标准化比率（INR）值范围从小于1.0到大于4.0。不同INR值的血浆输血数据显示为输血发作次数，给定的单位数量，或输血的DTIs的比例。当INR为1.5或更低时，临床医生在1.5％的情况下输注血浆，当INR小于2.0时，在2.2％的情况下输注血浆。仅在0.75％的DTI中输注血浆而没有红细胞。3个ICU之间的输血实践有统计学差异。
结论：与显示血液审核结果的传统方法相比，DTI分析显示有关决定是否输血和不输血的信息。基于决策时间分析显示数据的利用率审查揭示了临床实践模式，与传统的血浆审核数据显示所建议的模式截然不同。
方法：在重症监护病房（ICU）接受治疗的患者的回顾性研究，外科ICU,或2018年1月至2023年6月期间在一家学术医院进行心脏手术后ICU。每个患者的护理事件被分为一系列DTI。记录每个时间间隔期间的输血。
结果：总计，在111,557个时间间隔的护理中，有16,562名患者接受了6980单位的血浆和21,034单位的红细胞。患者的国际标准化比率（INR）值范围从小于1.0到大于4.0。不同INR值的血浆输血数据显示为输血发作次数，给定的单位数量，或输血的DTIs的比例。当INR为1.5或更低时，临床医生在1.5％的情况下输注血浆，当INR小于2.0时，在2.2％的情况下输注血浆。仅在0.75％的DTI中输注血浆而没有红细胞。3个ICU之间的输血实践有统计学差异。
结论：与显示血液审核结果的传统方法相比，DTI分析显示有关决定是否输血和不输血的信息。基于决策时间分析显示数据的利用率审查揭示了临床实践模式，与传统的血浆审核数据显示所建议的模式截然不同。
