Blood Use Management

Inpatient Hemoglobin Management

The Digital Intern’s Hemoglobin Management module for inpatient use will recommend an appropriate number of units of red blood cells to meet a target.  Providers choose the target for their patients.  The Digital Intern will also recommend an appropriate time to re-draw the lab.  In the case of a significant drop in hemoglobin, the Digital Intern may recommend an immediate re-draw to guard against errors (while also recommending starting to give red blood cells if indicated based on the current lab values and the patient’s vital signs).

The Digital Intern hemoglobin algorithm has been in use at the UWHC since 2016 and has reduced the units of red blood cells used by the hospital significantly.

Inpatient INR correction

The Digital Intern’s INR correction module will recommend appropriate steps to reach a target INR chosen by the provider taking into account the indications and time frame for INR reversal.  Recommended steps may include vitamin K, PCCs, and transfusion of plasma.

The Digital Intern INR correction algorithm has been in use at UWHC since 2017 and has reduced the amount of plasma used by approximately 160 units per month.

Inpatient Platelet Use

The Digital Intern’s platelet module will calculate an appropriate number of units to transfuse to reach a target specified by the provider.  The module will use information about past transfusions for the same patient to adjust its recommendations and determine whether the desired target can be reached.

Operating Room Hemoglobin Management

The Digital Intern Operating Room module uses the patient’s fluid I/O information, initial hemoglobin or hematocrit value, and estimated blood loss to recommend appropriate transfusions to keep the patient at or above a target hemoglobin or hematocrit level set by the provider. It will also recommend post transfusion follow-up labs.

Outpatient Hematology Clinics

The Digital Intern’s hematology clinic module makes recommendations based on a patient’s past transfusions and labs. It will become more accurate for an individual patient over time. The provider may specify a date for the patient to return to clinic and the Digital Intern will recommend the number of red blood cell units that need to be transfused today to keep the patient at or above the goal hemoglobin level until that return date. Alternately, the provider may specify the number of units to be transfused today and the Digital Intern will recommend a return date when it will be expected that the patient will need another transfusion.

This hemoglobin module has been in use at UWHC since 2017 and has made accurate predictions for more than 80% of patients.

We are also working to develop an outpatient platelet module which would function similarly and recommend the appropriate number of units or return date for platelet transfusions.

Albumin Stewardship

The Digital Intern Albumin module recommends the use Albumin when appropriate in the inpatient setting.