Patient blood management knowledge and practice among clinicians from seven European university hospitals: a multicentre survey

Abstract

Background and Objectives The aim of this survey was to evaluate the knowledge about Patient Blood Management (PBM) principles and practices amongst clinicians working in seven European hospitals participating in a European Blood Alliance (EBA) project.Materials and Methods A web-based questionnaire was sent to 4952 clinicians working in medical, surgery and anaesthesiology disciplines. The responses were analysed, and the overall results as well as a comparison between hospitals are presented.Results A total of 788 responses (16%) were obtained. About 24% of respondents were not aware of a correlation between preoperative anaemia (POA) and perioperative morbidity and mortality. For 22%, treatment of POA was unlikely to favourably influence morbidity and mortality even before surgery with expected blood loss. More than half of clinicians did not routinely treat POA. 29%, when asked which is the best way to treat deficiency anaemia preoperatively, answered that they did not have sufficient knowledge and 5% chose to 'do nothing'. Amongst those who treated POA, 38% proposed red cell transfusion prior to surgery as treatment. Restrictive haemoglobin triggers for red blood cell transfusion, single unit policy and reduction of number and volumes of blood samples for diagnostic purposes were only marginally implemented.Conclusion Overall, the responses indicated poor knowledge about PBM. Processes to diagnose and treat POA were not generally and homogeneously implemented. This survey should provide further impetus to implement programmes to improve knowledge and practice of PBM.

Programmes for the management of preoperative anaemia: audit in ten European hospitals within the PaBloE (Patient Blood Management in Europe) Working Group

“…A survey questioning clinicians working at hospitals within the PaBloE working group reported higher screening (90%) and treatment (37%) rates . When asked why they did not routinely treat for anaemia, the most common answer was lack of time and barriers in organization . This follow‐up study now presents data from 2016 about organization, infrastructure, responsibilities and financing of preoperative anaemia management programmes in various hospitals from Europe.…”

“…Since 2010 members of the WHO have been urged to promote PBM programmes . Although the risks of preoperative anaemia have been repeatedly demonstrated , the implementation of programmes to treat anaemia preoperatively is still scarce, with various studies reporting low screening and treatment rates . For instance, less than 25% of the 706 surveyed physicians in a study by Baron et al routinely assess patients for anaemia .…”

“…Furthermore, a study based on data from 11 hospitals from Europe and Canada showed that even if low Hb levels were diagnosed preoperatively treatment rates remained low . A survey questioning clinicians working at hospitals within the PaBloE working group reported higher screening (90%) and treatment (37%) rates . When asked why they did not routinely treat for anaemia, the most common answer was lack of time and barriers in organization .…”

“…In addition, identification of patients suffering from preoperative anaemia is not tantamount to a guaranteed treatment, as demonstrated in a study by Van der Linden et al in which the treatment rate of preoperative anaemia ranged between 0% and 41%. Furthermore, a previous survey conducted by the PaBloE working group showed that some clinicians still seem to be unaware of the association between preoperative anaemia and worse patient outcome . What is largely absent from the published literature so far is detailed information on organization, infrastructure, responsibilities and financing of preoperative anaemia management programmes.…”

Assessing our current practice: point prevalence studies in transfusion medicine

“…Transfusion practices have historically been assessed via large blood center surveys conducted by national transfusion medicine associations or surveys to practitioners to self‐assess their clinical decision making . Large surveys can assess the volume of transfusions of certain blood products and the places at which they are transfused, but lack specificity regarding indication for transfusion, clinical reasoning, or outcomes.…”