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.


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).


CONCLUSIONS
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.
Hematology Department, Fremantle Hospital, Fremantle, Western Australia, Australia; University of Western Australia, Perth, Western Australia, Australia.
Michael F
MF
Leahy
Heather
H
Roberts
S Aqif
SA
Mukhtar
Shannon
S
Farmer
Julie
J
Tovey
Val
V
Jewlachow
Tracy
T
Dixon
Peter
P
Lau
Michael
M
Ward
Matthew
M
Vodanovich
Kevin
K
Trentino
Paul C
PC
Kruger
Trudi
T
Gallagher
Audrey
A
Koay
Axel
A
Hofmann
James B
JB
Semmens
Simon
S
Towler
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001315:Australia / Q000453:epidemiology; D001771:Blood Banks / Q000458:organization & administration* / Q000592:standards / Q000706:statistics & numerical data; D001803:Blood Transfusion / Q000592:standards / Q000706:statistics & numerical data*; D002648:Child; D002675:Child, Preschool; D006284:Health Plan Implementation; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007297:Inpatients; D033183:Interdisciplinary Communication; D008505:Medical Staff, Hospital / Q000193:education; D008875:Middle Aged; D019106:Postoperative Hemorrhage / Q000453:epidemiology / Q000517:prevention & control; D062606:Tertiary Care Centers / Q000458:organization & administration*; D064826:Transfusion Medicine / Q000193:education; D055815:Young Adult