title: Patient-centered blood management.
abstract: BACKGROUND
  Transfusions are common in hospitalized patients but carry significant risk, with associated morbidity and mortality that increases with each unit of blood received. Clinical trials consistently support a conservative over a liberal approach to transfusion. Yet there remains wide variation in practice, and more than half of red cell transfusions may be inappropriate. Adopting a more comprehensive approach to the bleeding, coagulopathic, or anemic patient has the potential to improve patient care.
  
  
  METHODS
  We present a patient-centered blood management (PBM) paradigm. The 4 guiding principles of effective PBM that we present include anemia management, coagulation optimization, blood conservation, and patient-centered decision making.
  
  
  RESULTS
  PBM has the potential to decrease transfusion rates, decrease practice variation, and improve patient outcomes.
  
  
  CONCLUSIONS
  PBM's value proposition is highly aligned with that of hospital medicine. Hospitalists' dual role as front-line care providers and quality improvement leaders make them the ideal candidates to develop, implement, and practice PBM.
authors.affiliation: Department of Hospital Medicine, Geisinger Medical Center, Danville, Pennsylvania.
authors.forename: Benjamin
authors.initials: B
authors.lastname: Hohmuth
authors.forename: Sherri
authors.initials: S
authors.lastname: Ozawa
authors.forename: Maria
authors.initials: M
authors.lastname: Ashton
authors.forename: Richard L
authors.initials: RL
authors.lastname: Melseth
mesh_terms: D000740:Anemia / Q000175:diagnosis / Q000628:therapy; D001777:Blood Coagulation / Q000502:physiology; D016063:Blood Loss, Surgical / Q000517:prevention & control; D001803:Blood Transfusion / Q000379:methods / Q000592:standards*; D019468:Disease Management; D006801:Humans; D018802:Patient-Centered Care / Q000379:methods / Q000592:standards*; D058996:Quality Improvement / Q000592:standards* / Q000639:trends