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

Abstract

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.

Implementation of a patient blood management monitoring and feedback program significantly reduces transfusions and costs

“…Although lectures on the adverse effect of unfocused or uncritical liberal transfusions were presented at our center in all departments with a monitored obligation for physicians and nurses to attend, we may have introduced these guidelines with insufficient noticeable collateral activities. There was no real campaign with posters exhibited in the entire hospital, flyers, logo, eye‐catching intranet presence, and even shirts accompanying the guideline introduction as was done in Frankfurt when introducing PBM …”

“…There was no real campaign with posters exhibited in the entire hospital, flyers, logo, eye-catching intranet presence, and even shirts accompanying the guideline introduction as was done in Frankfurt when introducing PBM. 19 An important element missing at our center in late 2012 and early 2013 was a feedback to the clinicians on their transfusion behavior in comparison with their peers. This was achieved with the newly developed PBM monitoring and feedback program.…”

Towards a systematic approach for (de)implementation of patient blood management strategies

“…In contrast to the PBM implementation initiatives as described above, behavioural change literature in the field of transfusion medicine states that (de)implementation initiatives and (de)implementation studies should be preceded by the identification of the relevant barriers in the specific situation, including a problem analysis and favours to use interventions supported by literature (Francis et al, ; Islam et al, ; Gould et al, ; Lorencatto et al, ). This is also emphasised by literature on how to effectively implement PBM programmes (Farmer et al, ; Australia, ; Fischer et al, ; Meybohm et al, ,b). However, in several studies on the implementation of PBM programmes, both these processes are not described (Holt et al, ; Kopanidis et al, ; Loftus et al, ; Meybohm et al, ; Rineau et al, ; Rineau et al, ; Stein et al, ).…”

“…The implementation of techniques and guidelines has been described in transfusion medicine literature (Australia, 2014;Fischer et al, 2015;Fullenbach et al, 2017;Meybohm et al, 2017a). In this aspect, the implementation of new innovations and guidelines may be challenging and leaves room for improvement (Spahn et al, 2013;Baron et al, 2016;Eichbaum et al, 2016;Van der Linden & Hardy, 2016).…”

Patient Blood Management Bundles to Facilitate Implementation

“…Despite the demonstrated benefits of PBM, many barriers and challenges limit translation of PBM guidelines into clinical practice [22][23][24][25], in particular due to lack of knowledge (eg, staff members are not aware of the latest discoveries and new guidelines; imprudent practice is endorsed by common misconceptions), lack of interdisciplinary commitment (eg, many patients have contact with different clinicians from different departments with different opinions about the "best treatment"; resistance from hospital's "culture"), lack of resources (eg, limited staff with limited time; hospital administrators need to invest initially before saving money), and concerns (eg, PBM may initially "cut down" jobs in blood donor service or transfusion medicine).…”