Appropriate Use of Medical Resources: Patient Blood Management

In “Appropriate Use of Medical Resources,” a white paper released in November 2013, the American Hospital Association’s (AHA) Physician Leadership Forum (PLF) identified five areas where hospitals, in partnership with their clinical staff and patients, should look to reduce non-beneficial care. The PLF is releasing toolkits on each of the recommended areas. The first area of focus is appropriate blood management in inpatient services. To this end, AHA is collaborating with AABB and others to make leading-edge patient blood management (PBM) resources available to the hospital community via a new toolkit. To access the toolkit, click www.aha.org/appropriateuse.

Background

Clinical research has shown that restrictive transfusion practices are generally associated with better patient outcomes as well as reduced health care resource utilization. This evidence has emerged as providers are increasingly being urged to implement evidence-based clinical decision guidelines that improve the quality and efficiency of the care they deliver and measure patient outcomes. In light of these health care landscape changes, increased attention has been placed on the clinical decision to transfuse blood products.

A growing number of clinicians who order blood products are turning to PBM as an important component of their care planning decisions. PBM comprises a variety of methods, such as the use of evidence-based transfusion guidelines as well as anemia and coagulation management.

A general strategy for initiating a PBM program includes:

  • Commitment from hospital leadership to support the development and implementation of the program.
  • Development of a preoperative anemia management program.
  • Utilization of intraoperative strategies such as blood recovery, normovolemic hemodilution and component sequestration.
  • Implementation of point-of-care monitoring in the OR and ICU environments.
  • Establishment of an auditing mechanism to ensure reasonable blood utilization.

An evidence-based approach to blood utilization leading to blood usage reductions has the potential to substantially lower facility expenditures and improve patient outcomes, allowing those resources to be redirected to other areas of need within the hospital.

A great deal of work still remains to reduce the number of unnecessary transfusions in the U.S. To accelerate progress, an expanding number of major medical societies are making the appropriate use of blood an important area of focus.

Many hospitals in the U.S. have already embraced PBM and positive patient outcomes have resulted along with a reduction in the variation of practice within the institutions. A comprehensive PBM program has been shown to be a valuable tool to hospitals, hospital systems and clinicians as they strive to improve outcomes while lowering cost.

Toolkit Highlights

  • Online self-assessment tool to determine a hospital’s readiness for adopting a formal PBM program. Completing the self-assessment will result in a set of recommendations about next steps for PBM program implementation and direct you to the resources needed (www.ahaphysicianforum.org/PBM).
  • PBM webinar on May 1, 2014 at 2 p.m. ET which will include data and compelling evidence for the use of patient blood management to improve care and lower costs.
  • PBM Frequently Asked Questions (FAQs) which include the definition of PBM and requirement for an impactful and sustainable hospital-based program.
  • AABB clinical practice guidelines with medical staff and clinicians.
  • AABB iPhone app for additional PBM resources.
  • “Questions to Ask Your Provider” patient resource.

Further questions

If you have additional questions, please feel free to contact Elisa Arespacochaga, director, Physician Leadership Forum, at elisa@aha.org, or Jackie Thomas, director of Marketing and Corporate Relations, AABB, at jthomas@aabb.org.

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