The Patient Blood Management Project as part of the Perioperative Surgical Home concept
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Resident PGY 4
Henry Ford Hospital
Background: As of today, the prevalence of perioperative anemia is around 40%. Around one third of our patients presenting for elective procedures have some degree of anemia that is potentially treatable. Preoperative anemia, female gender and small body size represent the most common predictors of perioperative allogeneic blood transfusions. This latter embodies the utmost important factor affecting the outcome of our patients during the intra- and post-operative periods. Perioperative allogeneic blood transfusions have been associated to increased length of stay, hospital and intensive care unit readmissions as well as other collateral expenses and harms to the health system such as cost for blood conservation, potential for blood product wastage and burden in the national pool of donor. The concepts of Patient Blood Management (PBM) and Perioperative Surgical Home (PSH) merge with the goal of optimizing and promoting high value care, such as: decrease and optimize the number of patients undergoing elective surgical procedures with preoperative anemia through an organizational cultural change therefore minimizing the healthcare burdens previously mentioned. Methods: The authors present retrospective and prospective data generated from our institution before and after the PBM/PSH concept was implemented in the summer of 2017. Outcomes included perioperative degree of anemia, degree of anemia optimization, rate of blood transfusions and rate of readmissions. The main intervention from our study including the implementation of a perioperative algorithm and metrics focused on identifying patients that required preoperative anemia optimization and assuring following these patients in the anesthesia preop clinic.The retrospective portion of the data collection comprised 79 patients who underwent total hip or knee arthroplasty and Henry Ford Hospital Main Campus from December 2014 to December 2015. The prospective portion of the data collection included 518 patients undergoing similar procedures at same facility from January 2018 to July 2018. Results: Retrospective data results demonstrated 25% of preoperative anemia in the population analyzed (20 out of 79), 23% of perioperative blood transfusion (18 out of 79) and 35% readmission rate (28 out of 79). After intervention, prospective data results showed 20% prevalence of anemia (102 out of 518), 3.4% of perioperative blood transfusion (18 out of 518) and 4.6% of readmission rate (24 out of 518). Conclusions: The implementation of the PBM/PSH concept involves an enormous organizational cultural change as well as coordinated multi-specialty efforts in order to produce the desired results, but as demonstrated in our study, there is a significant decrease in the rate of perioperative blood transfusions and readmission rates, which is associated to decreased healthcare burden and costs.
Navas-Blanco, Jose R and Loyd, Gary, "The Patient Blood Management Project as part of the Perioperative Surgical Home concept" (2019). High Value Care. 2.