Transfusion medicine

The secret to successful patient blood management


The success of a pioneering patient blood management program developed in Western Australia illustrates the importance of multidisciplinary involvement and the support of national and state level government.

Dr Simon Towler, clinical lead for South Metropolitan Health Service and a staff specialist in Intensive Care at Fiona Stanley Hospital in Murdoch, Western Australia was presenting at the HAA 2017 Annual Scientific Meeting as part of the ANZSBT Symposium: Choosing Wisely.

During his talk, PBM’s impact on patient outcomes and economic consequences –the WA experience Dr Towler presented the results of a five year comprehensive health-system-wide PBM program initiated by the Western Australian Department of Health in 2008.

The retrospective study assessed over 600,000 patients that were admitted to four major adult tertiary-care hospitals between July 2008 and June 2014.

During the study period platelets transfused per admission decreased by 41% representing a saving of AU$18,507,092 and between AU$80 million and AU$100 million estimated activity-based savings.

Average pre-transfusion haemoglobin levels decreased from 7.9 g/dL to 7.3 g/dL and anaemic elective surgery admissions decreased 20.8% to 14.4%.

Single-unit RBC transfusions increased from 33.3% to 63.7% (p < 0.001).

There were also reductions in hospital mortality (odds ratio [OR], 0.72), hospital-acquired infections (OR, 0.79), and acute myocardial infarction-stroke (OR, 0.69).

“Mortality went down 28%… We’re not claiming causality, but what we are saying that we didn’t see adverse effects,” Dr Towler told delegates.

“Length of stay was also reduced. There was a problem with re-admission rates which we’ve been able to sort out,” he noted.

Dr Towler told delegates that the model had attracted international attention for its reduced blood transfusions, improved patient outcomes, and reduced costs.

It also provided strong evidence of what can be achieved with support from the national and state level governments.

The establishment of the National Blood Authority (NBA) was integral to the program’s success, as was the commitment of Australian transfusion haematologist Professor James Isbister who supported major change in care of patients with anaemia and coined the expression Patient Blood Management.

The study, ‘Improved outcomes and reduced costs associated with a health-system –wide patient blood management program’  was published in Transfusions in June 2017.

 

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