Development and feasibility of a Patient Blood Management implementation programme in vascular surgery

Abstract

Vascular surgery is the largest (non-cardiac) user of blood transfusion which is associated with increased risk to patients. Patient Blood Management (PBM) is a quality improvement programme in transfusion medicine involving educational change and recommendations through preoperative, operative, and postoperative surgery. We wished to assess the feasibility to implement a PBM programme in vascular surgery. A multidisciplinary programme was developed at a vascular unit by PBM experts. The PBM programme involved a series of educational lectures, consultations, and discussions with doctors, nurses, and theatre staff. A one-page PBM checklist of recommendations was developed for all patients undergoing vascular surgery. Prospective audits were conducted before (October 2014 to March 2015) and after (November 2015 to February 2016) PBM implementation. Outcomes were blood transfusion and haemoglobin concentration (Hb) trigger threshold. A total of 211 patients were admitted under vascular surgery: 127 for Audit 1 and 84 for Audit 2. Overall, 30% of patients were transfused, with 193 units transfused in Audit 1 and 85 in Audit 2. PBM implementation was associated with a reduction in patients receiving a blood transfusion (37% to 20%; p = 0.01). However, there was no difference in Hb trigger threshold (76 g/L vs 72 g/L, p = 0.051). A PBM programme is feasible and can be implemented in vascular surgery. PBM was associated with an improvement in transfusion use and length of patient stay that merits further investigation.

Education of medical personnel optimizes filling volume of blood culture bottles without negatively affecting microbiology testing

“…Vaghar reported an increase in nurses' level of knowledge about the risks of blood transfusion after an educational intervention [12]. Chau et al implemented a multidisciplinary patient blood management program at a vascular unit [18]. The implementation involved educational lectures, consultations, and discussions with doctors, nurses, and theater staff.…”

Consensus of the Brazilian association of hematology, hemotherapy and cellular therapy on patient blood management

“… Development of general PBM protocols and specific protocols for areas such as cardiology, transplants, obstetrics, vascular surgery, among others. 11 , 12 This includes pre-surgical outpatient PBM, transfusion algorithms, perioperative/inpatient protocols (covering the period before and after surgery), checklists for specific situations and massive transfusion protocols in cases such as postpartum, post-trauma, transplants and heart surgery. Incorporation of electronic support that assists in decision-making regarding transfusion practice, especially in surgical and clinical specialties.…”

Impact of Patient Blood Management on Red Blood Cell Utilization in an Urban Community Teaching Hospital: A Seven-Year Retrospective Study

“…One of our key strategies employed was the use of broad-based educational modules [2] for licensed practitioners. These modules were updated and provided annual education, especially for new attending physicians, residents, fellows, physician assistants, and nurse practitioners.…”