Implementation of a "Patient Blood Management" program in medium sized hospitals: Results of a survey among German hemotherapists.

Abstract

Germany uses more blood transfusions than the majority of other countries. The objective of this study was to detect the degree of Patient Blood Management (PBM) implementation within Germany and to identify obstacles to establishing PBM programs. An electronical questionnaire containing 21 questions and 4 topics was sent in 2018 to the members of the German interdisciplinary hemotherapy (IAKH) society in Germany. The degree of PBM (described as pre-, intra-, postoperative period) was established via questions within the topics "management of preoperative anemia" (PA) (n = 5), "preoperative management and transfusion preparation" (n = 3), PBM organization and structure (n = 5), coagulation management (n = 3), perioperative transfusion performance and habits (n = 3), best practices and problems (n = 2). 533 German hospitals with transfusion activity received the questionnaire with a 32.5% response rate to the survey. A dedicated PBM program had not been established in a quarter of all small and medium sized institutions. Red blood cell transfusion was the only therapeutic option in a third of institutions. Approximately half of the hospitals did not use knowledge of PArates or transfusion needs of surgical procedures. Institutions failed to implement PBM because of a lack of profit, workload, personnel shortage, and administrative support. PBM was not present in at least a quarter of the hospitals interrogated. Factors for improvement were the relationship between health care disciplines and sectors, economic incentives, inclusion of relevant disciplines, and the structure of the blood industry. To improve BPM implementation, hospitals need support to implement top-down PBM projects.