A Programmatic Approach to Patient Blood Management – Reducing Transfusions and Improving Patient Outcomes

Shannon L Farmer,Axel Hofmann,Jeffrey M Hamdorf,Michael F Leahy,Gareth Prosser,James B Semmens,Kevin Trentino,Sudhakar Rao,S Aqif Mukhtar

doi:10.2174/1874321801509010006

Abstract

In July 2008, the Western Australia (WA) Department of Health embarked on a landmark 5-year project to implement a sustainable comprehensive health-system-wide Patient Blood Management Program. Fundamentally, it was a quality and safety initiative, which also had profound resource and economic implications. Unsustainable escalating direct and indirect costs of blood, potentially severe blood shortages due to changing population dynamics, donor deferrals, loss of altruism, wide variations in transfusion practice and growing knowledge of transfusion limitations and adverse outcomes necessitate a paradigm shift in the management of anemia and blood loss. The concept of patient-focused blood management is proving to be an effective force for change. This approach has now evolved to embrace comprehensive hospital-wide Patient Blood Management Programs. These programs show significant reductions in blood utilisation, and costs while achieving similar or improved patient outcomes. The WA Program is achieving these outcomes across a health jurisdiction in a sustained manner.

Highlights

Patient blood management (PBM) shifts the attention in transfusion medicine from a product focus to a patient focus and managing the patient’s own blood [1]
This review found that in cardiac and non-cardiac surgery, red blood cell (RBC) transfusion is independently associated with increased morbidity, intensive care unit (ICU) and hospital length of stay and mortality
The Western Australia (WA) PBM Program was announced in November 2008 in the State that had one of the lowest transfusion rates in the developed world [32]

Summary

INTRODUCTION

Patient blood management (PBM) shifts the attention in transfusion medicine from a product focus to a patient focus and managing the patient’s own blood [1]. Based on an exhaustive review of the literature the NBA Patient Blood Management Guidelines: Module 2 Perioperative contains an evidence-based recommendation that “Health-care services should establish a multidisciplinary, multimodal perioperative patient blood management program” [10]. Numerous reports in the literature show that these programs are achieving change, resulting in significant reductions in blood utilisation while improving patient outcomes and reducing costs (see Fig. 1) [9, 11,12,13,14,15,16,17,18,19,20,21,22,23,24,25,26,27,28,29,30]. A provisional blood conservation program in Ontario Canada in 2002 was the

A Programmatic Approach to Patient Blood Management

Exploit and optimise the tolerance of anemia

RESULTS

CONCLUSION

CONFLICT OF INTEREST