title: Patient blood management implementation strategies and their effect on physicians' risk perception, clinical knowledge and perioperative practice - the frankfurt experience.
abstract: BACKGROUND
  A multicomponent, evidence-based and interdisciplinary Patient Blood Management (PBM) program was introduced at the University Hospital Frankfurt in July 2013. The implementation strategy included practical and tactical components aimed to increase knowledge on the risks of preoperative anemia, to standardize hemotherapy, and to facilitate PBM components.
  
  
  METHODS
  This article analyzes barriers to PBM implementation and outlines a strategy to introduce and manifest PBM. The effects in Frankfurt were measured in a before and after questionnaire study distributed among groups of physicians immediately before and 1 year after PBM implementation.
  
  
  RESULTS
  142 clinicians completed the questionnaire in July 2013 and 101 clinicians in August 2014. Absolute certainty that the treatment of preoperative anemia favorably influences morbidity and mortality rose from 25 to 37%. Transfusion behavior seems to have been affected: In 2014, 56% of clinicians stated that they clinically reassess the patient and analyze hemoglobin following each single red blood cell unit compared to only 38% stating this in 2013.
  
  
  CONCLUSIONS
  These results show that our implementation strategy was effective in changing physicians' risk perception, attitude, and knowledge on PBM principles. Our experience highlights key success factors for the implementation of a comprehensive PBM program.
authors.affiliation: Department of Anesthesiology, Intensive Care Medicine and Pain Therapy, University Hospital Frankfurt, Frankfurt/M., Germany.
authors.forename: Dania P
authors.initials: DP
authors.lastname: Fischer
authors.affiliation: Department of Anesthesiology, Intensive Care Medicine and Pain Therapy, University Hospital Frankfurt, Frankfurt/M., Germany.
authors.forename: Kai D
authors.initials: KD
authors.lastname: Zacharowski
authors.affiliation: German Red Cross Blood Transfusion Service Baden-Wuerttemberg - Hessen, Institute of Transfusion Medicine and Immunohematology, Frankfurt/M., Germany.
authors.forename: Markus M
authors.initials: MM
authors.lastname: Müller
authors.affiliation: German Red Cross Blood Transfusion Service Baden-Wuerttemberg - Hessen, Institute of Transfusion Medicine and Immunohematology, Frankfurt/M., Germany.
authors.forename: Christof
authors.initials: C
authors.lastname: Geisen
authors.affiliation: German Red Cross Blood Transfusion Service Baden-Wuerttemberg - Hessen, Institute of Transfusion Medicine and Immunohematology, Frankfurt/M., Germany.
authors.forename: Erhard
authors.initials: E
authors.lastname: Seifried
authors.affiliation: Department of Anesthesiology, Intensive Care Medicine and Pain Therapy, University Hospital Frankfurt, Frankfurt/M., Germany.
authors.forename: Heiko
authors.initials: H
authors.lastname: Müller
authors.affiliation: Department of Anesthesiology, Intensive Care Medicine and Pain Therapy, University Hospital Frankfurt, Frankfurt/M., Germany.
authors.forename: Patrick
authors.initials: P
authors.lastname: Meybohm
keywords: Anemia; Blood transfusion; Implementation strategy; Medical decision-making; Patient blood management; Surgery – preoperative period