Improved outcomes and reduced costs associated with a health-system-wide patient blood management program: a retrospective observational study in four major adult tertiary-care hospitals.
Patient blood management (PBM) programs are associated with improved patient outcomes, reduced transfusions and costs. In 2008, the Western Australia Department of Health initiated a comprehensive health-system-wide PBM program. This study assesses program outcomes.



This was a retrospective study of 605,046 patients admitted to four major adult tertiary-care hospitals between July 2008 and June 2014. Outcome measures were red blood cell (RBC), fresh-frozen plasma (FFP), and platelet units transfused; single-unit RBC transfusions; pretransfusion hemoglobin levels; elective surgery patients anemic at admission; product and activity-based costs of transfusion; in-hospital mortality; length of stay; 28-day all-cause emergency readmissions; and hospital-acquired complications.



Comparing final year with baseline, units of RBCs, FFP, and platelets transfused per admission decreased 41% (p < 0.001), representing a saving of AU$18,507,092 (US$18,078,258) and between AU$80 million and AU$100 million (US$78 million and US$97 million) estimated activity-based savings. Mean pretransfusion hemoglobin levels decreased 7.9 g/dL to 7.3 g/dL (p < 0.001), and anemic elective surgery admissions decreased 20.8% to 14.4% (p = 0.001). Single-unit RBC transfusions increased from 33.3% to 63.7% (p < 0.001). There were risk-adjusted reductions in hospital mortality (odds ratio [OR], 0.72; 95% confidence interval [CI], 0.67-0.77; p < 0.001), length of stay (incidence rate ratio, 0.85; 95% CI, 0.84-0.87; p < 0.001), hospital-acquired infections (OR, 0.79; 95% CI, 0.73-0.86; p < 0.001), and acute myocardial infarction-stroke (OR, 0.69; 95% CI, 0.58-0.82; p < 0.001). All-cause emergency readmissions increased (OR, 1.06; 95% CI, 1.02-1.10; p = 0.001).



Implementation of a unique, jurisdiction-wide PBM program was associated with improved patient outcomes, reduced blood product utilization, and product-related cost savings.
School of Medicine and Pharmacology, The University of Western Australia.|Department of Haematology, Royal Perth Hospital.|PathWest Laboratory Medicine, Royal Perth Hospital, Perth, Western Australia, Australia.
Michael F
MF
Leahy
Department of Anesthesiology, University Hospital Zurich, Zurich, Switzerland.|School of Surgery, University of Western Australia.|Centre for Population Health Research, Curtin University, Perth, Western Australia, Australia.
Axel
A
Hofmann
Service 4, Fiona Stanley Hospital, Murdoch, Western Australia, Australia.
Simon
S
Towler
Business Intelligence Unit, South Metropolitan Health Service.
Kevin M
KM
Trentino
School of Medicine and Pharmacology, The University of Western Australia.
Sally A
SA
Burrows
Business Intelligence Unit, South Metropolitan Health Service.
Stuart G
SG
Swain
School of Surgery, Faculty of Medicine Dentistry and Health Sciences, The University of Western Australia.|Clinical Training and Evaluation Centre (CTEC), University of Western Australia, Perth, Western Australia, Australia.
Jeffrey
J
Hamdorf
Department of Health, Western Australia, Australia.|Accumen LLC, San Diego, California.
Trudi
T
Gallagher
Department of Health, Western Australia, Australia.
Audrey
A
Koay
Department of Health, Western Australia, Australia.|School of Paediatrics and Child Health and School of Primary and Aboriginal and Rural Health, The University of Western Australia, Perth, Western Australia, Australia.
Gary C
GC
Geelhoed
School of Surgery, Faculty of Medicine Dentistry and Health Sciences, The University of Western Australia.|Centre for Population Health Research, Faculty of Health Sciences, Curtin University, Perth, Western Australia, Australia.
Shannon L
SL
Farmer
D000328:Adult; D001315:Australia; D001803:Blood Transfusion / Q000191:economics* / Q000401:mortality / Q000706:statistics & numerical data*; D017707:Erythrocyte Transfusion / Q000191:economics / Q000401:mortality / Q000706:statistics & numerical data; D017052:Hospital Mortality; D006761:Hospitals / Q000706:statistics & numerical data*; D006801:Humans; D007902:Length of Stay; D012189:Retrospective Studies