TY - JOUR
T1 - Development and feasibility of a Patient Blood Management implementation programme in vascular surgery
AU - Chau, Marisa
AU - Gohil, Divisha
AU - Schofield, Nick
AU - Abeysiri, Sandaruwani
AU - Klein, Andrew A.
AU - Richards, Toby
N1 - Funding Information:
https://orcid.org/0000-0003-2965-1870 Chau Marisa 1 Gohil Divisha 1 Schofield Nick 2 Abeysiri Sandaruwani 1 Klein Andrew A 3 Richards Toby 1 1 Division of Surgery & Interventional Science, University College London, London, UK 2 Royal Free Perioperative Research Group, Royal Free Hospital, London, UK 3 Department of Anaesthesia, Royal Papworth Hospital, Cambridge, UK Toby Richards, Division of Surgery & Interventional Science, University College London, Charles Bell House, 43–45 Foley Street, London W1W 7TS, UK. Email: [email protected] Dr Matthew Corriere served as Guest Editor for this manuscript. 11 2019 1358863X19883940 © The Author(s) 2019 2019 SAGE Publications Vascular surgery is the largest (non-cardiac) user of blood transfusion which is associated with increased risk to patients. Patient Blood Management (PBM) is a quality improvement programme in transfusion medicine involving educational change and recommendations through preoperative, operative, and postoperative surgery. We wished to assess the feasibility to implement a PBM programme in vascular surgery. A multidisciplinary programme was developed at a vascular unit by PBM experts. The PBM programme involved a series of educational lectures, consultations, and discussions with doctors, nurses, and theatre staff. A one-page PBM checklist of recommendations was developed for all patients undergoing vascular surgery. Prospective audits were conducted before (October 2014 to March 2015) and after (November 2015 to February 2016) PBM implementation. Outcomes were blood transfusion and haemoglobin concentration (Hb) trigger threshold. A total of 211 patients were admitted under vascular surgery: 127 for Audit 1 and 84 for Audit 2. Overall, 30% of patients were transfused, with 193 units transfused in Audit 1 and 85 in Audit 2. PBM implementation was associated with a reduction in patients receiving a blood transfusion (37% to 20%; p = 0.01). However, there was no difference in Hb trigger threshold (76 g/L vs 72 g/L, p = 0.051). A PBM programme is feasible and can be implemented in vascular surgery. PBM was associated with an improvement in transfusion use and length of patient stay that merits further investigation. blood transfusion implementation science patient blood management quality improvement edited-state corrected-proof Declaration of conflicting interests The authors declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: there is no external or industry involvement in this project. MC: salary – supported by Pharmacosmos A/S. DG: no conflict of interests declared. NS: no conflict of interests declared. SA: no conflict of interests declared. AK: AK or his institution has received educational grant funding, honoraria or travel expenses from Fisher and Paykel, Pharmacosmos, Vifor Pharma, Masimo, Hemonetics, and Hemosonics. TR: grants – NIHR HTA (UK), NHMRC (Australia), NIAA / BJA / ACTA / VASGBI (UK), Mason Medical Research Foundation, UCH League of Friends; grants, personal fees, and nonfinancial support – Pharmacosmos, Vifor Pharma, Acelity, Stroke Association; grants and nonfinancial support – Libresse / Bodyform; all outside the submitted work. TR is a regular speaker at national and international conferences on anaemia, blood transfusion, wound healing, and vascular diseases, for which he has received expenses for travel, accommodation, and sundries. TR is the Director of The Iron Clinic Ltd, Director of Veincare London Ltd, and is also the vascular lead for 18-week wait Ltd. Funding The authors received no financial support for the research, authorship, and/or publication of this article. ORCID iD Marisa Chau https://orcid.org/0000-0003-2965-1870 Supplemental material The supplementary material is available online with the article.
Publisher Copyright:
© The Author(s) 2019.
PY - 2020/2
Y1 - 2020/2
N2 - Vascular surgery is the largest (non-cardiac) user of blood transfusion which is associated with increased risk to patients. Patient Blood Management (PBM) is a quality improvement programme in transfusion medicine involving educational change and recommendations through preoperative, operative, and postoperative surgery. We wished to assess the feasibility to implement a PBM programme in vascular surgery. A multidisciplinary programme was developed at a vascular unit by PBM experts. The PBM programme involved a series of educational lectures, consultations, and discussions with doctors, nurses, and theatre staff. A one-page PBM checklist of recommendations was developed for all patients undergoing vascular surgery. Prospective audits were conducted before (October 2014 to March 2015) and after (November 2015 to February 2016) PBM implementation. Outcomes were blood transfusion and haemoglobin concentration (Hb) trigger threshold. A total of 211 patients were admitted under vascular surgery: 127 for Audit 1 and 84 for Audit 2. Overall, 30% of patients were transfused, with 193 units transfused in Audit 1 and 85 in Audit 2. PBM implementation was associated with a reduction in patients receiving a blood transfusion (37% to 20%; p = 0.01). However, there was no difference in Hb trigger threshold (76 g/L vs 72 g/L, p = 0.051). A PBM programme is feasible and can be implemented in vascular surgery. PBM was associated with an improvement in transfusion use and length of patient stay that merits further investigation.
AB - Vascular surgery is the largest (non-cardiac) user of blood transfusion which is associated with increased risk to patients. Patient Blood Management (PBM) is a quality improvement programme in transfusion medicine involving educational change and recommendations through preoperative, operative, and postoperative surgery. We wished to assess the feasibility to implement a PBM programme in vascular surgery. A multidisciplinary programme was developed at a vascular unit by PBM experts. The PBM programme involved a series of educational lectures, consultations, and discussions with doctors, nurses, and theatre staff. A one-page PBM checklist of recommendations was developed for all patients undergoing vascular surgery. Prospective audits were conducted before (October 2014 to March 2015) and after (November 2015 to February 2016) PBM implementation. Outcomes were blood transfusion and haemoglobin concentration (Hb) trigger threshold. A total of 211 patients were admitted under vascular surgery: 127 for Audit 1 and 84 for Audit 2. Overall, 30% of patients were transfused, with 193 units transfused in Audit 1 and 85 in Audit 2. PBM implementation was associated with a reduction in patients receiving a blood transfusion (37% to 20%; p = 0.01). However, there was no difference in Hb trigger threshold (76 g/L vs 72 g/L, p = 0.051). A PBM programme is feasible and can be implemented in vascular surgery. PBM was associated with an improvement in transfusion use and length of patient stay that merits further investigation.
KW - blood transfusion
KW - implementation science
KW - patient blood management
KW - quality improvement
UR - http://www.scopus.com/inward/record.url?scp=85075182752&partnerID=8YFLogxK
U2 - 10.1177/1358863X19883940
DO - 10.1177/1358863X19883940
M3 - Article
C2 - 31729285
AN - SCOPUS:85075182752
SN - 1358-863X
VL - 25
SP - 41
EP - 46
JO - Vascular Medicine
JF - Vascular Medicine
IS - 1
ER -