A pragmatic approach to embedding patient blood management in a tertiary hospital
- SF has received consulting/lecture honoraria or travel support from Western Australian Department of Health; Queensland Department of Health; New South Wales Department of Health; South Australia Department of Health; Australian Red Cross Blood Service; Australian National Blood Authority; Australian Jurisdictional Blood Committee; Novo Nordisk; Vifor Pharma Ltd, Glattbrugg, Switzerland; Johnson & Johnson Ethicon Biosurgery, USA; Medtel Pty Ltd, Australia. TG has received travel support from the Western Australian Department of Health, Australian Red Cross Blood Service, and Queensland Department of Health and has received conference registration funds from the Society for the Advancement of Blood Management and Kaiser Permanente. AH is currently receiving consulting fees from the Western Australian Department of Health. In the past 5 years, Dr Hofmann has received grant support from the Federal Austrian Ministry of Health, honoraria or travel support for consulting or lecturing from the following companies and legal entities: Amgen GmbH, Switzerland; Australian Red Cross Blood Service, Brisbane, Australia; CSL Behring GmbH, Marburg, Germany; Dynabyte GmbH, Munich, Germany; Fresenius Kabi GmbH, Bad Homburg, Germany; Haemonetics GmbH, Munich, Germany; Janssen-Cilag GmbH, Austria; Johnson & Johnson Ethicon Biosurgery, USA; Novo Nordisk A/S, Bagsvärd, Denmark; Pentapharm/TEM GmbH, Germany; United Biosource Corporation, Bethesda, Maryland; Vifor Pharma Ltd, Glattbrugg, Switzerland; The Society for the Advancement of Blood Management, USA; The Medical Society for Blood Management, Austria; and The Institute for Patient Blood Management & Bloodless Medicine and Surgery, Englewood, NJ.
- The Patient Blood Management Program at Fremantle Hospital receives financial support from the Western Australian Department of Health.
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.
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).
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.