A pragmatic approach to embedding patient blood management in a tertiary hospital

Leahy, Michael F.; Roberts, H.; Mukhtar, Syed Aqif; Farmer, Shannon; Tovey, Julie; Jewlachow, V.; Dixon, Tracy; Lau, Peter; Ward, Marie; Vodanovich, M.; Trentino, Kevin M.; Krüger, Paul-Christian; Gallagher, Trudi; Koay, Audrey; Hofmann, Axel; Semmens, James B.; Towler, Simon

doi:10.1111/trf.12362

Cited by 85 publications

(82 citation statements)

References 23 publications

(43 reference statements)

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“…A composite endpoint is analyzed including in hospital mortality and morbidity, such as sepsis, myocardial infarction, stroke, renal failure and pneumonia, before and after the implementation of PBM. It is expected that PBM will reduce the incidence of preoperative anemia in elective patients, result in lower blood product usage, and will thereby potentially reduce costs and complications and improve individual patient outcome as it has already been shown in other trials [32,34]. Such high-quality data will also help to sustain the program through positive feedback to the medical experts.…”

Section: Patient Blood Managementmentioning

confidence: 99%

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Patient Blood Management Implementation Strategies and Their Effect on Physicians' Risk Perception, Clinical Knowledge and Perioperative Practice - the Frankfurt Experience

Fischer

Zacharowski

Müller

et al. 2015

Transfus Med Hemother

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Introduction: A multicomponent, evidence-based and interdisciplinary Patient Blood Management (PBM) program was introduced at the University Hospital Frankfurt in July 2013. The implementation strategy included practical and tactical components aimed to increase knowledge on the risks of preoperative anemia, to standardize hemotherapy, and to facilitate PBM components. Methods: This article analyzes barriers to PBM implementation and outlines a strategy to introduce and manifest PBM. The effects in Frankfurt were measured in a before and after questionnaire study distributed among groups of physicians immediately before and 1 year after PBM implementation. Results: 142 clinicians completed the questionnaire in July 2013 and 101 clinicians in August 2014. Absolute certainty that the treatment of preoperative anemia favorably influences morbidity and mortality rose from 25 to 37%. Transfusion behavior seems to have been affected: In 2014, 56% of clinicians stated that they clinically reassess the patient and analyze hemoglobin following each single red blood cell unit compared to only 38% stating this in 2013. Conclusion: These results show that our implementation strategy was effective in changing physicians' risk perception, attitude, and knowledge on PBM principles. Our experience highlights key success factors for the implementation of a comprehensive PBM program.

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Section: Patient Blood Managementmentioning

confidence: 99%

“…Quality assessment of the new standard of care is one way to successfully enhance the acceptance of PBM [31,32,33]. Periodic assessment of physicians' PBM competency and advocate accountability to organizational standards as part of ongoing professional practice evaluation should be scheduled.…”

Section: Patient Blood Managementmentioning

confidence: 99%

Patient Blood Management Implementation Strategies and Their Effect on Physicians' Risk Perception, Clinical Knowledge and Perioperative Practice - the Frankfurt Experience

Fischer

Zacharowski

Müller

et al. 2015

Transfus Med Hemother

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“…Indication for transfusion takes into consideration patient specific factors (eg, age, diagnosis, comorbidity), laboratory values (eg, hemoglobin, platelet count, coagulation testing), presence or absence of bleeding, and physiologic factors (eg, oxygenation, hemodynamic status). When RBC transfusion is clinically indicated in the nonbleeding patient, only a single unit of RBC should be prescribed, followed by clinical reassessment of the patient ("single unit policy"; "transfuse and assess strategy") [17,19]. Interestingly, the general terminology for blood components is unit, bags, and others, but the concept of dosage is still not used apart from coagulation factors.…”

Section: Patient-centered Decision Makingmentioning

confidence: 98%

“…There is a large amount of research evidence that the successful implementation of PBM reduces perioperative blood loss and transfusion needs [13][14][15][16][17][18][19][20], perioperative morbidity [13,16], mortality [14,16], length of hospital stay [14,16], and costs [21]. In this respect, the World Health Organization has officially been urging member states to implement PBM since 2010 (WHA63.12).…”

mentioning

confidence: 99%

“…In this respect, the World Health Organization has officially been urging member states to implement PBM since 2010 (WHA63.12). Patient blood management programs have already been rolled out successfully in some hospitals in Western Australia [19], Europe [13,18], United States [14,17], and now starting in Asia. Notable, outside Australia, no national PBM programs have been established, and many hospitals worldwide seek guidance with its implementation.…”

mentioning

confidence: 99%

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Patient Blood Management Bundles to Facilitate Implementation

Meybohm

Richards

Isbister

et al. 2017

Transfusion Medicine Reviews

Self Cite

189

125

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More than 30% of the world's population are anemic with serious economic consequences including reduced work capacity and other obstacles to national welfare and development. Red blood cell transfusion is the mainstay to correct anemia, but it is also 1 of the top 5 overused procedures. Patient blood management (PBM) is a proactive, patient-centered, and multidisciplinary approach to manage anemia, optimize hemostasis, minimize iatrogenic blood loss, and harness tolerance to anemia. Although the World Health Organization has endorsed PBM in 2010, many hospitals still seek guidance with the implementation of PBM in clinical routine. Given the use of proven change management principles, we propose simple, cost-effective measures enabling any hospital to reduce both anemia and red blood cell transfusions in surgical and medical patients. This article provides comprehensive bundles of PBM components encompassing 107 different PBM measures, divided into 6 bundle blocks acting as a working template to develop institutions' individual PBM practices for hospitals beginning a program or trying to improve an already existing program. A stepwise selection of the most feasible measures will facilitate the implementation of PBM. In this manner, PBM represents a new quality and safety standard.

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Patient Blood Management

Mueller

Remoortel

Meybohm

et al. 2019

JAMA

465

146

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IMPORTANCE Blood transfusion is one of the most frequently used therapies worldwide and is associated with benefits, risks, and costs. OBJECTIVE To develop a set of evidence-based recommendations for patient blood management (PBM) and for research. EVIDENCE REVIEWThe scientific committee developed 17 Population/Intervention/ Comparison/Outcome (PICO) questions for red blood cell (RBC) transfusion in adult patients in 3 areas: preoperative anemia (3 questions), RBC transfusion thresholds (11 questions), and implementation of PBM programs (3 questions). These questions guided the literature search in 4 biomedical databases (MEDLINE, EMBASE, Cochrane Library, Transfusion Evidence Library), searched from inception to January 2018. Meta-analyses were conducted with the GRADE (Grading of Recommendations, Assessment, Development, and Evaluation) methodology and the Evidence-to-Decision framework by 3 panels including clinical and scientific experts, nurses, patient representatives, and methodologists, to develop clinical recommendations during a consensus conference in Frankfurt/Main, Germany, in April 2018.FINDINGS From 17 607 literature citations associated with the 17 PICO questions, 145 studies, including 63 randomized clinical trials with 23 143 patients and 82 observational studies with more than 4 million patients, were analyzed. For preoperative anemia, 4 clinical and 3 research recommendations were developed, including the strong recommendation to detect and manage anemia sufficiently early before major elective surgery. For RBC transfusion thresholds, 4 clinical and 6 research recommendations were developed, including 2 strong clinical recommendations for critically ill but clinically stable intensive care patients with or without septic shock (recommended threshold for RBC transfusion, hemoglobin concentration <7 g/dL) as well as for patients undergoing cardiac surgery (recommended threshold for RBC transfusion, hemoglobin concentration <7.5 g/dL). For implementation of PBM programs, 2 clinical and 3 research recommendations were developed, including recommendations to implement comprehensive PBM programs and to use electronic decision support systems (both conditional recommendations) to improve appropriate RBC utilization. CONCLUSIONS AND RELEVANCEThe 2018 PBM International Consensus Conference defined the current status of the PBM evidence base for practice and research purposes and established 10 clinical recommendations and 12 research recommendations for preoperative anemia, RBC transfusion thresholds for adults, and implementation of PBM programs. The relative paucity of strong evidence to answer many of the PICO questions supports the need for additional research and an international consensus for accepted definitions and hemoglobin thresholds, as well as clinically meaningful end points for multicenter trials.

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A pragmatic approach to embedding patient blood management in a tertiary hospital

Cited by 85 publications

References 23 publications

Patient Blood Management Implementation Strategies and Their Effect on Physicians' Risk Perception, Clinical Knowledge and Perioperative Practice - the Frankfurt Experience

Patient Blood Management Implementation Strategies and Their Effect on Physicians' Risk Perception, Clinical Knowledge and Perioperative Practice - the Frankfurt Experience

Patient Blood Management Bundles to Facilitate Implementation

Patient Blood Management

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