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Transfusion Recommendations Implemented in the PICU (TRIP)

Award Number: R18HS029298
ORGANIZATION: AGENCY FOR HEALTH CARE RESEARCH AND QUALITY
OPDIV: AHRQ
AWARD CLASS: DISCRETIONARY
AWARD ACTIVITY TYPE: KDA (KNOWLEDGE/DEVELOPMENT/APPLICATION)
PERIOD OF PERFORMANCE START DATE: 05/01/2023
PERIOD OF PERFORMANCE END DATE: 04/30/2027

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Transfusion Recommendations Implemented in the PICU (TRIP) - Project Summary/Abstract Red blood cell (RBC) transfusions are commonly administered in the pediatric intensive care unit (PICU) with the goal of increasing oxygen delivery; however, storage of RBCs may limit efficacy to prevent or reverse oxygen debt. RBC transfusions have been independently associated with increased PICU morbidity and mortality and impart additional risk to patients due to infectious and non-infectious serious hazards of transfusion. Evidence-based guidelines were developed to restrict transfusion to those patients most likely to benefit. Liberal transfusion practices persist; however, placing nearly one quarter million children annually admitted to the PICU at risk for harm from transfusions. Threshold-based guidelines exist for hemodynamically stable patients with a hemoglobin (Hb) >7 g/dL where evidence is robust, whereas clinical judgement is recommended when Hb is 5-7 g/dL or in hemodynamically unstable patients with a Hb > 7 g/dL. Qualitative study of barriers and facilitators to implementation of the transfusion guidelines and intervention mapping informed the development of a bundle of implementation strategies directed at addressing specific contextual barriers to routine adoption of the transfusion guidelines in the PICU. The bundle of strategies, informed by the Consolidated Framework for Implementation Research (CFIR) includes building consensus, identifying, and empowering champions, educating providers, use of integrated computerized clinical decision support (CCDS) tools, and providing quantitative metric-based feedback to providers. The proposed pilot study aims to address two critical gaps in operationalization and evaluation of the implementation bundle across institutions that are necessary prior to execution of a multi-center type 2 hybrid effectiveness and implementation trial to formally evaluate the implementation bundle. These include the need for 1) validated, electronic cohort characterization of patients at-risk for unnecessary RBC transfusion and 2) optimization and integration of CCDS tools, which are anticipated to pose the greatest operational challenges in a multi-site study. Thus, we propose the following specific aims: Specific Aim 1. Create and validate a computable phenotype for a dynamic cohort of PICU patients at-risk for unnecessary transfusion, including children eligible for threshold-based and/or clinical judgment-based CCDS tools Specific Aim 2. Deploy and assess implementation of Computerized Clinical Decision Support (CCDS) tools as one component of the transfusion implementation bundle. Evaluation of the CCDS tools using a customized version of the RE-AIM evaluative implementation framework for clinical informatics will facilitate further optimization of the tools.


Issue Date FY	Funding FY	Legal Entity Name	Legal Entity Address	Legal Entity City	Legal Entity State	Legal Entity Zip Code	Legal Entity COUNTY	Legal Entity COUNTRY	Assistance Listing	Award Code	Budget Year	Action Date	Action Type	Action Amount

Issue Date FY: 2026 ( Subtotal = $0 )
2026	2025	THE LELAND STANFORD JUNIOR UNIVERSITY	450 JANE STANFORD WAY	STANFORD	CA	94305	SANTA CLARA	USA	Research on Healthcare Costs, Quality and Outcomes	000	3	3/2/2026	NON-COMPETING CONTINUATION	$0
														Subtotal = $0

Issue Date FY: 2025 ( Subtotal = $357,434 )
2025	2025	THE LELAND STANFORD JUNIOR UNIVERSITY	450 JANE STANFORD WAY	STANFORD	CA	94305	SANTA CLARA	USA	Research on Healthcare Costs, Quality and Outcomes	000	3	6/4/2025	NON-COMPETING CONTINUATION	$357,434
														Subtotal = $357,434

Issue Date FY: 2024 ( Subtotal = $375,718 )
2024	2024	THE LELAND STANFORD JUNIOR UNIVERSITY	450 JANE STANFORD WAY	STANFORD	CA	94305	SANTA CLARA	USA	Research on Healthcare Costs, Quality and Outcomes	001	2	4/18/2024	NON-COMPETING CONTINUATION	$375,718
2024	2023	THE LELAND STANFORD JUNIOR UNIVERSITY	450 JANE STANFORD WAY	STANFORD	CA	94305	SANTA CLARA	USA	Research on Healthcare Costs, Quality and Outcomes	000	1	10/25/2023	NEW	$0
														Subtotal = $375,718

Issue Date FY: 2023 ( Subtotal = $397,998 )
2023	2023	THE LELAND STANFORD JUNIOR UNIVERSITY	450 JANE STANFORD WAY	STANFORD	CA	94305	SANTA CLARA	USA	Research on Healthcare Costs, Quality and Outcomes	000	1	4/19/2023	NEW	$397,998
														Subtotal = $397,998

Grand Total All Awards = $1,131,150

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Transfusion Recommendations Implemented in the PICU (TRIP)

Award Number: R18HS029298

ORGANIZATION: AGENCY FOR HEALTH CARE RESEARCH AND QUALITY

OPDIV: AHRQ

AWARD CLASS: DISCRETIONARY

AWARD ACTIVITY TYPE: KDA (KNOWLEDGE/DEVELOPMENT/APPLICATION)

PERIOD OF PERFORMANCE START DATE: 05/01/2023

PERIOD OF PERFORMANCE END DATE: 04/30/2027

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