Provision of peri-operative patient blood management strategies in the UK: a national survey of practice

Abstract

Introduction: In UK hospitals, it is unclear how organisational structures are arranged to support effective implementation of peri-operative blood management practice strategies. The aim of this study was to conduct a national survey of organisations to describe local practices of peri-operative patient blood management and infrastructure availability in the UK.

Methods: A series of benchmarking standards was developed using recommendations informed by national standards, relevant literature and an expert panel. Through the Research and Audit Federation of Trainees networks, 143 hospitals were approached to participate. The pre-piloted survey was conducted online between January and February 2023.

Results: Responses were received from 123 hospitals across 74 NHS Trusts and health boards. Formal elective anaemia pathways were not reported in 37/123 (30%) sites. There was considerable inter-site variation in interventional thresholds for anaemia and screening tests. A variety of oral iron regimens were reported, from once-daily dosing in 41/85 (48%) sites, to three times a day dosing in 14/85 (16%). Ferric carboxymaltose was the preparation used most frequently at sites that administered intravenous iron (61/113, 54%). There was variation between hospitals and surgical specialties in the use of tranexamic acid with 49/122 (39%) hospitals reporting a policy for the use of peri-operative tranexamic acid. For sites that performed major surgery routinely (irrespective of specialty), 20/112 (18%) included tranexamic acid in operating theatre safety briefings. Point-of-care coagulation testing was available at 62/123 (50%) sites.

Discussion: Our findings show considerable heterogeneity in peri-operative patient blood management strategies and supporting infrastructure availability across the UK. There is a pressing need for hospitals to review pathways of care offered to surgical patients and implement national recommendations.

Keywords: blood transfusion; iron; patient blood management; peri‐operative; tranexamic acid.

Figure 1

Site identification and recruitment to survey.

Figure 2

A geographical representation of the proportional response rates of sites per Trainee Research Network (School of Anaesthesia) [30]. Darker shades indicate higher response rates. Highest response rates (76–100%) MERCAT (East Midlands); NITECAP (Northern Ireland); SWARM (Peninsula); and WAAREN (Wales). Lowest response rate 0% CRANE (Northern); SEQUOIA (East of Scotland); No TRN (North Scotland).