Improving Awareness about Patient Blood Management in Portugal: A Call for Action Arising from a Delphi Panel

Abstract

Introduction: Anaemia and iron deficiency are associated with increased mortality and poor surgical outcomes. Consensus in their definitions is expected to optimize their management, which is encompassed by patient blood management, providing patient-centred care while improving patient safety and clinical outcomes. Patient blood management implementation is even more relevant in contingency times and faces barriers due to lack of standardization, among others. The aim is to establish a consensus on these diagnoses and implement patient blood management principles in clinical practice in Portugal.Material and Methods: Eight experts in Transfusion Medicine, Haematology, Anaesthesiology, Internal Medicine, and Obstetrics/Gynaecology were assembled; a focus group was conducted, defining 33 statements. A Delphi panel was conducted, with experts from the clinical specialities named above as well as from General Surgery, Urology, and Orthopaedics.Results: The Delphi panel’s rounds had 70 (Round 1) and 46 (Round 2) respondents. Specialists were consensual in only two statements, on the existence of a preoperative patient blood management consultation for candidates to elective surgeries in which the use of blood derivatives is anticipated and, on the importance of the correction of postoperative anaemia and iron deficiency. Of the remaining 31 statements, 27 reached high agreement or disagreement by the respondents.Conclusion: Consensus was reached in only two (6%) of the 33 statements. There was a consensual agreement on the relevance of establishing patient blood management as the standard of care and of valuing preoperative and postoperative patient blood management interventions. Nevertheless, our results point to the lack of awareness regarding patient blood management principles – which could result in better postoperative outcomes, shorter hospitalizations, reduced costs and increased availability of beds. Training and literacy initiatives could help further implement patient blood management standards in Portuguese hospitals.

Appraisal of awareness of medical staff about preoperative patient blood management in Saudi Arabia: questionnaire based study

“…In its wider de nition, this inventive multidisciplinary approach includes the treatment of perioperative anemia and iron de ciency. In order to supply patient-centered services, the integration of PBM precepts into clinical practice and hospital-based procedures has been linked to enhancements in patient safety and clinical outcomes [3,4]. These precepts are particularly important in emergency cases, when the cornerstone of PBM (the physiological reserve of anemia) and its restrictive transfusion approaches [5] are applicable.…”

“…Blood transfusion is considered as useful tool in management of many diseases especially anemia, and blood loss, being performed in approximately 10-15% of all hospitalizations worldwide, although of many improvement policies have been implemented in last decades, blood transfusion is still associated with mortal dangers [1]. PBM entails the correct and timely implementation of evidence-based notions that aim to keep hemoglobin concentration, optimize hemostasis, and reduce blood loss in order to increase patient outcomes [2]. In its wider de nition, this inventive multidisciplinary approach includes the treatment of perioperative anemia and iron de ciency.…”