Improved outcomes and reduced costs associated with a health‐system–wide patient blood management program: a retrospective observational study in four major adult tertiary‐care hospitals
Tóm tắt
Patient blood management (PBM) programs are associated with improved patient outcomes, reduced transfusions and costs. In 2008, the Western Australia Department of Health initiated a comprehensive health‐system–wide PBM program. This study assesses program outcomes.
This was a retrospective study of 605,046 patients admitted to four major adult tertiary‐care hospitals between July 2008 and June 2014. Outcome measures were red blood cell (RBC), fresh‐frozen plasma (FFP), and platelet units transfused; single‐unit RBC transfusions; pretransfusion hemoglobin levels; elective surgery patients anemic at admission; product and activity‐based costs of transfusion; in‐hospital mortality; length of stay; 28‐day all‐cause emergency readmissions; and hospital‐acquired complications.
Comparing final year with baseline, units of RBCs, FFP, and platelets transfused per admission decreased 41% (p < 0.001), representing a saving of AU$18,507,092 (US$18,078,258) and between AU$80 million and AU$100 million (US$78 million and US$97 million) estimated activity‐based savings. Mean pretransfusion hemoglobin levels decreased 7.9 g/dL to 7.3 g/dL (p < 0.001), and anemic elective surgery admissions decreased 20.8% to 14.4% (p = 0.001). Single‐unit RBC transfusions increased from 33.3% to 63.7% (p < 0.001). There were risk‐adjusted reductions in hospital mortality (odds ratio [OR], 0.72; 95% confidence interval [CI], 0.67‐0.77; p < 0.001), length of stay (incidence rate ratio, 0.85; 95% CI, 0.84‐0.87; p < 0.001), hospital‐acquired infections (OR, 0.79; 95% CI, 0.73‐0.86; p < 0.001), and acute myocardial infarction‐stroke (OR, 0.69; 95% CI, 0.58‐0.82; p < 0.001). All‐cause emergency readmissions increased (OR, 1.06; 95% CI, 1.02‐1.10; p = 0.001).
Implementation of a unique, jurisdiction‐wide PBM program was associated with improved patient outcomes, reduced blood product utilization, and product‐related cost savings.
Từ khóa
Tài liệu tham khảo
Farmer S, 2016, Patient blood management, 207
Australian Commission on Safety and Quality in Health Care. What is Patient Blood Management? Sydney Australia: Australian Commission on Safety and Quality in Health Care [cited 2015 Feb 13]. Available from:http://www.safetyandquality.gov.au/national-priorities/pbm-collaborative/what-is-patient-blood-management/.
National Blood Authority.Patient Blood Management. Canberra Australia: National Blood Authority (Australia) [cited2016Mar 22]. Available from:http://www.blood.gov.au/patient-blood-management-pbm.
National Blood Authority. Patient Blood Management Guidelines: Module 2‐Perioperative. Canberra Australia: National Blood Authority (Australia);2012[cited 2016 Dec 02]. Available from:http://www.nba.gov.au/pbm-guidelines.
Australian Commission on Safety and Quality in Health Care.National Priorities. Sydney Australia: Australian Commission on Safety and Quality in Health Care [cited2016Nov 24]. Available from:https://www.safetyandquality.gov.au/national-priorities/.
Australian Commission on Safety and Quality in Health Care.National Standards and Accreditation. Sydney Australia: Australian Commission on Safety and Quality in Health Care [cited2016Nov 24]. Available from:https://www.safetyandquality.gov.au/our-work/national-standards-and-accreditation/.
Hofmann A, 2007, Western Australia Patient Blood Management Project 2008‐2012: Analysis, Strategy, Implementation and Financial Projections, 1
US Department of Health and Human Services. The 2011 National Blood Collection and Utilization Survey Report. US Department of Health and Human Services
2012 [cited 2016 Dec 02]. Available fromhttps://www.aabb.org/research/hemovigilance/bloodsurvey/Documents/11-nbcus-report.pdf.
Kotter J, 2002, The heart of change
Kotter JP, 1979, Choosing strategies for change, Harv Bus Rev, 57, 106
National Blood Authority (Australia).Patient Blood Management Guidelines. National Blood Authority (Australia) 2008. [cited 2016 July 14]. Available fromhttp://www.blood.gov.au/pbm-guidelines.
Farmer S, 2016, Patient blood management, 19
Mikkola R, 2012, Use of blood products and risk of stroke after coronary artery bypass surgery, Blood Transfus, 10, 490
Estcourt LJ, 2015, Comparison of different platelet count thresholds to guide administration of prophylactic platelet transfusion for preventing bleeding in people with haematological disorders after myelosuppressive chemotherapy or stem cell transplantation, Cochrane Database Syst Rev, CD010983
Haas DA, 2015, The Mayo Clinic Model for running a value‐improvement program [Internet], Harvard Business Rev
AABB.Patient Blood Management. Bethesda (MD): AABB. [cited 2016 Nov 24]. Available from:http://www.aabb.org/pbm/Pages/default.aspx.
National Health Service.Patient Blood Management. NHS Blood and Transplant [cited 2016 Nov 24]. Available from:http://hospital.blood.co.uk/patient-services/patient-blood-management/.
European Union.European Guide on Good Practices for Patient Blood Management (PBM). Brussels Belgium: European Union; 2016 [cited 2016 Nov 24]. Available from:http://www.europe-pbm.eu.