PATIENT BLOOD MANAGEMENT PROGRAMS INTRODUCTION TO PATIENT BLOOD MANAGEMENT PROGRAMS GETTING STARTED

DEFINITION Patient Blood Management is the timely application of evidence based medical and surgical concepts designed to manage anemia, optimize hemostasis, and minimize blood loss in order to improve patient outcomes.

PATIENT BLOOD MANAGEMENT GENERAL PRINCIPLES

Patient Blood Management Principles and Modalities

Patient Blood Management Principles and Modalities

Patient Blood Management Principles and Modalities

Patient Blood Management Principles and Modalities

rationale Improves clinical outcomes Improves hospital efficiency Decreases cost and resource consumption Improves patient experience and hospital reputation with healthier results

rationale Improves regulatory compliance that ties reimbursement to patient outcomes Demonstrates application of scientific evidence and best practices Can increase revenue by expanding patient base (e.g., medical tourism)

rationale National Recognition e.g., US Dept of Health and Human Resources Regulatory focus on transfusion avoidance e.g., Joint Commission Growth of PBM-related clinical guidelines amongst professional organizations e.g., STS, SCA, ESA, ASH, SHM, AABB, CAP, AHA, etc. International endorsement of PBM programs e.g., Western Australia, Ontario Province, Canada, World Health Organization, Republic of China/Ministry of Health/Depart of Blood Management, etc.

Rationale – a closer look High frequency of blood transfusion has led to overuse i.e., inappropriate practices No or poor measures of quality supporting transfusion practice Transfusions are associated with negative outcomes Prevalence of pre-surgical anemia Incidence of hospital-acquired anemia (HAA)

Modifying Risk Correcting pre-operative anemia Evaluating and addressing pre-operative bleeding risk Prevention of Hospital-Acquired Anemia (HAA) Controlling excessive bleeding Adjusting the transfusion threshold

PBM Programsimpact on Patient Outcomes SOURCE: SABM Executive Guide for Patient Blood Management Programs©, 2019

PBM Aligns with regulatory compliance Fiscally responsible Clinically superior Patient-centered Aligns with value based reimbursement and quality models

Stakeholders Executive Sponsor Medical Director and Program Manager Physicians from high blood use service lines e.g., CTS, Ortho, OB/GYN, Oncology Anesthesia Hospital Medicine Pediatrics Nursing leaders from high blood use/risk areas Patient safety officer Quality Dept. IS or IT Pharmacy Nursing educators Finance Lab/transfusion services

PBM Strategic IMPLEMENTATION Among the Core elements to strategic implementation, this slide deck will shift focus on validation of PBM Best Practices—and their alignment with hospital strategic goals

PBM Programs: Getting Started Evaluate blood utilization by hospital service, DRG, and physician Write a project charter or business plan w/budget Engage clinical and administrative leaders Use the SABM Standards and Quality Guide Align a PBM metric with a hospital quality initiative and financial goal

SABM resources: Getting Started

SABM Standards: Intent and Purpose Spans all hospital activities related to PBM Optimize clinical outcomes and improve patient safety Accelerate adoption of evidenced-based practices and clinical guidelines in any institution Bring proven treatment and management strategies that improve patient outcomes to the bedside RESOURCES: Moving from the Lab to the Bedside

SABM Quality Guide: Intent & Purpose Effectively measure program quality Monitor adherence to the SABM Standards Monitor the impact of PBM modalities Evaluate PBMP for performance improvement opportunities

Sabm resources: executive guide

Benchmarking: Transfusion rates by service line/procedures Transfusion practice by physician Number of blood components units transfused Number or % of elective surgery patients admitted w/HGB<13 and # of units transfused and LOS Identify high use service lines; data collection on current transfusion, surgical blood loss, lab draws and practice variation Find the cost of transfusion locally Benchmark with the literature: cost savings, decrease in complications and resource utilization Make the case for efficient care—less cost, lower LOS, better outcomes

Moving forward Transfusion-related outcomes Infections & complications Length of stay (ICU, vent times) Anemia management Use of pre-op anemia protocols Discharge Hgb Iatrogenic anemia (e.g., diagnostic, cath lab) Surgical bleeding Program evaluation and quality improvement is much more than transfusion utilization review and must include systematic evaluation of all PBM treatment modalities. This evaluation could include: % of complications e.g.,(CVA, DVT, MI, PE, Sepsis and LOS in transfused vs. non-transfused adjusted for acuity and comorbidities % readmissions in 30 days in Txd vs Non-Txd per DRG/Service/Procedure Compare % of 1-unit transfusion orders in non-hemorrhaging pts w/double (2) unit transfusion orders bi-annually % of non-ICU pts w/standing daily orders for lab testing (CBC & BMP) daily % use of anti-fibrinolytics in THA, TKA or CVT Surgery and transfusion rates NOTE: See how the PBM Bundle, SABM Standards are aligned with a metric—and how they meet hospital goals

Aligning PBM Metrics to Hospital goAls Identify a metric that will: Improve an operational process to achieve greater efficiency Improve a clinical process that impacts patient outcomes Increase operating income Achieve cost-savings There should always be opportunities to improve as the program evolves, hardwires processes and meets improvement targets. 16 examples can be found in the SABM Executive Guide.

SUMMARY Improves patient outcomes Improves efficiency and quality Less complications Decreased morbidity and mortality Improves efficiency and quality Reduces waste (overuse and cost) Improves patient experience Demonstrates evidence based (best) practice Improves hospital/physician reimbursement

PBM Program Essential Resources SABM Executive Guide for Patient Blood Management Programs Blood utilization metrics PBM metrics SABM Standards SABM Quality Guide SABM Annual Meeting and Scientific Program