A Pragmatic Approach to Embedding Patient Blood Management in a Tertiary Hospital

BACKGROUND:

We describe the implementation and impact of a patient blood management program (PBMP) in an Australian teaching hospital.

STUDY DESIGN AND METHODS:

A
PBMP was introduced at a single tertiary care hospital in 2009 as a
pilot for the Western Australian Health Department statewide PBMP. The
first 3 years of interventions aimed to make effective use of
preoperative clinics, manage perioperative anemia, improve perioperative
hemostasis, reduce blood sample volumes, and implement restrictive
transfusion triggers and a single-unit transfusion policy.

RESULTS:

Between
2008 and 2011, admissions to Fremantle Hospital and Health Services
increased by 22%. Using 2008 as a reference year, the mean number of red
blood cell (RBC) units per admission declined 26% by 2011. Use of
fresh-frozen plasma and platelets showed 38 and 16% declines,
respectively. Cryoprecipitate increased 7% over the 4-year period. For
elective admissions between 2008 and 2011, the leading decline in RBC
transfusion rate was seen in cardiothoracic surgery (27.5% to 12.8%).
The proportion of single RBC unit use increased from 13% to 28%
(p < 0.001), and the proportion of double units decreased from 48% to 37% (p < 0.001).

CONCLUSION:

This is the first
tertiary hospital in Australia to establish a multidisciplinary
multimodal PBMP. Interventions across disciplines resulted in decreased
use of RBC units especially in orthopedic and cardiothoracic surgery.
Continuing education and feedback to specialties will maintain the
program, improve patient outcomes, and decrease the transfusion rate.