A Potential Indicator for Assessing Patient Blood Management Standard Implementation

(1) Background: Patient blood management (PBM) program as a multidisciplinary practice and a standard of care for the anemic surgical patient has an increasingly important role in reducing transfusions and optimizing both clinical outcomes and costs. Documented success of PBM implementation is not sufficient for implementation of recommendations and correct use at hospital level. The primary objective of our study was to define a composite patient blood management process safety index—Safety Index in PBM (SIPBM)—that measures the impact of screening and treating anemic patients on the efficiency and effectiveness of the patient care process undergoing elective surgery. (2) Methods: We conducted a retrospective comparative study in a tertiary hospital by collecting data and analyzing the Safety Index in PBM (SIPBM) in patients undergoing major elective surgical procedures. (3) Results: The percentage of patients from the total of 354 patients (178 in 2019 and 176 in 2022) included in the study who benefited from preoperative iron treatment increased in 2022 compared to 2019 from 27.40% to 36.71%. The median value of the SIPBM was 1.00 in both periods analyzed, although there is a significant difference between the two periods (p < 0.005), in favor of 2022. (4) Conclusions: Measuring the effectiveness of PBM implementation and providing ongoing feedback through the Safety Index in PBM (SIPBM) increases the degree to which opportunities to improve the PBM process are identified. The study represents a first step for future actions and baselines to develop tools to measure the safety and impact of the patient blood management process in the surgical field.

[1]  A. Robalo Nunes,et al.  Clinical, economical and safety impact of ferric carboxymaltose use in Patient Blood Management programme in Portuguese National Health Service hospitals , 2022, Scientific Reports.

[2]  T. Abbott,et al.  Perioperative blood transfusion in major abdominal cancer surgery: a multi-centre service evaluation and national survey , 2022, BJA open.

[3]  T. Seyfried,et al.  Cell Salvage at the ICU , 2022, Journal of clinical medicine.

[4]  Jenna M. Evans,et al.  Selecting Performance Indicators and Targets in Health Care: An International Scoping Review and Standardized Process Framework , 2022, Risk management and healthcare policy.

[5]  S. Frank,et al.  A Global Definition of Patient Blood Management , 2022, Anesthesia and analgesia.

[6]  W. Groot,et al.  The impact of hospital accreditation on the quality of healthcare: a systematic literature review , 2021, BMC Health Services Research.

[7]  Jong Hoon Park,et al.  Making patient blood management the new norm(al) as experienced by implementors in diverse countries , 2021, BMC Health Services Research.

[8]  R. Gammon,et al.  Patient blood management—it is about transfusing blood appropriately , 2021, Annals of Blood.

[9]  A. Livraghi,et al.  How to implement of patient blood management pillar 1: An Italian expert opinion based on a "bundles" approach. , 2020, Transfusion and apheresis science : official journal of the World Apheresis Association : official journal of the European Society for Haemapheresis.

[10]  J. Isbister,et al.  Patient blood management: The best approach to transfusion medicine risk management. , 2020, Transfusion and apheresis science : official journal of the World Apheresis Association : official journal of the European Society for Haemapheresis.

[11]  J. Hardy,et al.  Overcoming barriers to evidence-based patient blood management: a restricted review , 2020, Implementation science : IS.

[12]  C. Lundgren,et al.  Patient blood management: A solution for South Africa , 2019, South African medical journal = Suid-Afrikaanse tydskrif vir geneeskunde.

[13]  J. Freedman,et al.  Multimodal Patient Blood Management Program Based on a Three-pillar Strategy: A Systematic Review and Meta-analysis , 2019, Annals of surgery.

[14]  M. Franchini,et al.  Patient Blood Management: a revolutionary approach to transfusion medicine. , 2019, Blood transfusion = Trasfusione del sangue.

[15]  Brenton G. Abadie,et al.  Choosing implementation strategies to address contextual barriers: diversity in recommendations and future directions , 2019, Implementation Science.

[16]  Benjamin Brown,et al.  Clinical Performance Feedback Intervention Theory (CP-FIT): a new theory for designing, implementing, and evaluating feedback in health care based on a systematic review and meta-synthesis of qualitative research , 2019, Implementation Science.

[17]  J. Vincent,et al.  The European guideline on management of major bleeding and coagulopathy following trauma: fifth edition , 2019, Critical Care.

[18]  S. Goobie,et al.  Society for the advancement of blood management administrative and clinical standards for patient blood management programs. 4th edition (pediatric version) , 2019, Paediatric anaesthesia.

[19]  C. Samama,et al.  Patient blood management in obstetrics: prevention and treatment of postpartum haemorrhage. A NATA consensus statement. , 2019, Blood transfusion = Trasfusione del sangue.

[20]  S. Johnsen,et al.  Consecutive cycles of hospital accreditation: Persistent low compliance associated with higher mortality and longer length of stay , 2018, International journal for quality in health care : journal of the International Society for Quality in Health Care.

[21]  A. Koster,et al.  2017 EACTS/EACTA Guidelines on patient blood management for adult cardiac surgery. , 2017, Journal of cardiothoracic and vascular anesthesia.

[22]  P. Wouters,et al.  Management of severe perioperative bleeding: guidelines from the European Society of Anaesthesiology: First update 2016. , 2017, European journal of anaesthesiology.

[23]  T. Richards,et al.  Patient blood management to reduce surgical risk , 2015, The British journal of surgery.

[24]  R. Pearse,et al.  Meta‐analysis of the association between preoperative anaemia and mortality after surgery , 2015, The British journal of surgery.

[25]  H. Kehlet,et al.  'Fit to fly': overcoming barriers to preoperative haemoglobin optimization in surgical patients. , 2015, British journal of anaesthesia.

[26]  E. Swenson,et al.  Anemia in critical illness: insights into etiology, consequences, and management. , 2012, American journal of respiratory and critical care medicine.

[27]  Gurmukh Singh,et al.  Patient blood transfusion management: discharge hemoglobin level as a surrogate marker for red blood cell utilization appropriateness , 2012, Transfusion.

[28]  T. Richards,et al.  Patient blood management in Europe , 2012, British journal of anaesthesia.

[29]  H. Gombotz,et al.  Patient Blood Management: A Patient-Orientated Approach to Blood Replacement with the Goal of Reducing Anemia, Blood Loss and the Need for Blood Transfusion in Elective Surgery , 2012, Transfusion Medicine and Hemotherapy.

[30]  F. Jamali,et al.  Preoperative anaemia and postoperative outcomes in non-cardiac surgery: a retrospective cohort study , 2011, The Lancet.

[31]  D. Spahn,et al.  Patient Blood Management: Effectiveness and Future Potential. , 2008, Anesthesiology.

[32]  L. Goodnough,et al.  Objectives and limitations of bloodless medical care , 2006, Current opinion in hematology.

[33]  H. Stähelin.  Guidelines , 1994, Communicating Science.

[34]  THE WORLD HEALTH ORGANIZATION , 1954 .

[35]  Laurelize Pereira Rocha,et al.  Patient safety culture in intensive care units: perspective of health professionals. , 2019, Revista gaucha de enfermagem.

[36]  A. Koster,et al.  2017 EACTS/EACTA Guidelines on patient blood management for adult cardiac surgery. , 2018, European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery.

[37]  Marisa B. Marques,et al.  Patient Blood Management , 2018 .

[38]  William R. Hendee,et al.  To Err is Human: Building a Safer Health System , 2001 .

[39]  Hematology, Transfusion and Cell Therapy Implementation of a patient blood management program based on a low-income country-adapted clinical decision support system , 2022 .