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

2. 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.

3. PATIENT BLOOD MANAGEMENT GENERAL PRINCIPLES

4. Patient Blood Management Principles and Modalities

5. Patient Blood Management Principles and Modalities

6. Patient Blood Management Principles and Modalities

7. Patient Blood Management Principles and Modalities

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

9. 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)

10. 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.

11. 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)

12. 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

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

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

15. 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

16. 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

17. 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

18. SABM resources: Getting Started

19. 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

20. 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

21. Sabm resources: executive guide

22. 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

23. 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

24. 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.

25. 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

26. 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