The success of our patient blood management program depended on an institution-wide change in transfusion practices

Abstract

Background: Patient blood management (PBM) programs seek to optimize the utilization of blood components. Since our institution's program started, the annual number of red blood cell (RBC) units transfused has decreased by 27% overall.

Study design and methods: We collected data for 6 months in 2007 (pre-PBM) compared with the same months in 2011 (post-PBM) to determine which changes in practice decreased RBC utilization. Indications for transfusion of nonsurgical patients were collected from the electronic medical records, while surgical indications were assigned to the admitting physician's specialty.

Results: Pre-PBM, we transfused 19,888 RBC units for a mean of 0.96 units per patient discharged, compared with 14,472 post-PBM, for a mean of 0.55 units per discharge. This represents a 43% reduction in RBC units transfused per patient discharged. While transfusion episodes decreased only slightly from 9519 to 9261, the success can be explained by the overall reduction in mean number of units per transfusion from 2 to 1.5 (p < 0.0001). Pre-PBM, 22 and 48% of patients received 1 or 2 units of RBCs per transfusion episode, respectively, while in 2011, the percentages were 51 and 33%, respectively (p < 0.0001). The mean number of RBC units per transfusion decreased significantly for approximately 50% of the indications.

Conclusion: Our success was achieved through hospital-wide physician buy-in toward a restrictive transfusion approach. We hope to encourage others to consider PBM for improved patient outcomes and blood conservation.