Becker's Hospital Review

68 Executive Briefing: Patient Blood Management Sponsored by E ach year, approximately 5 million Americans receive blood transfu- sions, according to the National Heart, Lung, and Blood Institute. Mostly, these are patients who have experienced blood loss from an injury or surgery, or pa- tients with certain illnesses such as ane- mia or hemophilia. Traditionally, hospital leaders have con- sidered blood transfusions a commonly needed therapy and an unavoidable cost of doing business. Today, however, patient blood management programs can help hospitals reduce and on many occasions eliminate the need for blood transfusions, which in turn can help improve patient out- comes while significantly reducing health- care costs. What is patient blood management? According to the Society for the Advance- ment of Blood Management, PBM is the scientific use of safe and effective medi- cal and surgical techniques designed to prevent anemia and decrease bleeding in an effort to improve patient outcomes. The AABB, or American Association of Blood Banks, more narrowly defines PBM as an evidence-based, multidisciplinary ap- proach to optimizing the care of patients who might need a transfusion. Basically, PBM is a set of strategies that can help hospitals reduce or eliminate the number of blood transfusions they perform by properly addressing the medical condi- tions of those patients. One of many important strategies of PBM is optimizing patients prior to surgery. If a cli- nician can determine whether a patient is at increased risk for a transfusion before the procedure, then he or she can take steps to reduce the likelihood that a transfusion will be needed. Patients with anemia are prime examples of cases in which pre-surgery optimization can be most effective. Anemia, a condition marked by a deficiency of red blood cells, affects nearly 2 billion people worldwide, according to the World Health Organization. And research shows that anywhere from 30 to 40 percent of patients who undergo elective surgery are anemic. Anemia is an independent risk factor for all sorts of complications, including increased risk of death. When clinicians test patients for anemia three to four weeks prior to sur- gery, they have time to identify the type of anemia (such as an iron deficiency) and treat it with various drug or hormone thera- pies to bring blood cell counts to normal levels and lower the likelihood of anemia- related complications as well as complica- tions associated with a transfusion. Additionally, PBM promotes blood con- servation through techniques such as minimizing the number of times a patient's blood is drawn for testing prior to and after surgery — because repeated blood draws can lead to anemia resulting in unneces- sary transfusions. PBM strategies also help minimize blood loss during proce- dures through the use of surgical devices and pharmaceutical agents that control bleeding, by managing anesthesia and flu- ids and by using techniques that salvage a patient's own blood. Improving outcomes, lower- ing costs Hospitals that implement PBM programs can achieve significant reductions in the number of transfusions they perform. For most facilities, a 20 to 30 percent reduc- tion is common. Some hospitals with par- ticularly aggressive goals have achieved reductions of 50 percent or more. By lowering the number of avoidable trans- fusions, hospitals reduce the number of Patient Blood Management Improves Outcomes, Lowers Costs By Aryeh Shander, MD, FCCM, FCCP, Director of Research, TeamHealth Anesthesia Patient blood management is the scientific use of safe and effective medical and surgical techniques designed to prevent anemia and decrease bleeding in an effort to improve patient outcomes.

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