Abstract
Background and objectivesPatient Blood Management (PBM) aims to optimize the care of patients who might need a blood transfusion. The International Consensus Conference on PBM (ICC‐PBM) aimed to develop evidence‐based recommendations on three topics: preoperative anaemia, red blood cell transfusion thresholds and implementation of PBM programmes. This paper reports how evidence‐based methodologies and technologies were used to enhance shared decision‐making in formulating recommendations during the ICC‐PBM.Materials & MethodsSystematic reviews on 17 PICO (Population, Intervention, Comparison, Outcomes) questions were conducted by a Scientific Committee (22 international topic experts and one methodologist) according to GRADE (Grades of Recommendation, Assessment, Development and Evaluation) methodology. Evidence‐based recommendations were formulated using Consensus Development Conference methodology.ResultsWe screened 17 607 references and included 145 studies. The overall certainty in the evidence of effect estimates was generally low or very low. During the ICC, plenary sessions (100–200 stakeholders from a range of clinical disciplines and community representatives) were followed by closed sessions where multidisciplinary decision‐making panels (>50 experts and patient organizations) formulated recommendations. Two chairs (content‐expert and methodologist) moderated each session and two rapporteurs documented the discussions. The Evidence‐to‐Decision template (GRADEpro software) was used as the central basis in the process of formulating recommendations.ConclusionThis ICC‐PBM resulted in 10 clinical and 12 research recommendations supported by an international stakeholder group of experts in blood transfusion. Systematic, rigorous and transparent evidence‐based methodology in a formal consensus format should be the new standard to evaluate (cost‐) effectiveness of medical treatments, such as blood transfusion.
Highlights
Patient Blood Management (PBM) is a patient-focused, evidence-based and multidisciplinary approach to optimize both the management of patients and transfusion of blood products for quality and effective patient care
The different co-sponsors of the International Consensus Conference on PBM (ICC-PBM) were acknowledged followed by a brief introduction of the three PBM topics, and the composition of the three corresponding decision-making panels tasked to formulate evidence-based recommendations were presented
For the first time in the field of PBM, and after two years of preparation, clinical bedside experts from anaesthesiology, haemostasis and thrombosis, intensive care medicine, transfusion medicine, internal medicine, neurology, clinical laboratory medicine, haematology, clinical immunology, oncology, neurosurgery, vascular, cardiac and oncological surgery, gynaecology and obstetrics met with nurses, patient and blood banking representatives, representatives of blood transfusion services and government authorities, Evidence-Based Medicine methodologists as well as epidemiologists for a two-day intensive exchange guided by the GRADE methodology
Summary
Patient Blood Management (PBM) is a patient-focused, evidence-based and multidisciplinary approach to optimize both the management of patients and transfusion of blood products for quality and effective patient care. Key areas in PBM include diagnosing and treating perioperative anaemia, implementing blood-saving measures throughout the course of diagnosis and treatment, and transfusing patients according to accepted and evidencebased transfusion thresholds. GRADE is a transparent framework for developing and presenting summaries of evidence and provides a systematic approach for making clinical practice recommendations [3,4,5]. Management (PBM) aims to optimize the care of patients who might need a blood transfusion. The International Consensus Conference on PBM (ICC-PBM) aimed to develop evidence-based recommendations on three topics: preoperative anaemia, red blood cell transfusion thresholds and implementation of PBM programmes. This paper reports how evidence-based methodologies and technologies were used to enhance shared decision-making in formulating recommendations during the ICC-PBM
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