Patient Blood Management Bundles to Facilitate Implementation

Patrick Meybohm a,⁎, Toby Richards b, James Isbister c, Axel Hofmann d, Aryeh Shander e, Lawrence Tim Goodnough f, Manuel Muñoz g, Hans Gombotz h, Christian FriedrichWeber a, Suma Choorapoikayil a, Donat R. Spahn i, Kai Zacharowski a

^{a Department of Anaesthesiology, Intensive Care Medicine and Pain Therapy, University Hospital Frankfurt, Frankfurt am Main, Germany}

^{b Centre for CardioVascular and Interventional Research (CAVIAR), University College London, London, United Kingdom}

^{c Department of Haematology and Transfusion Medicine, Sydney Medical School, Royal North Shore Hospital of Sydney, Sydney, Australia}

^{d Institute of Anaesthesiology, University and University Hospital Zurich, Zurich, Switzerland}

^{e Department of Anaesthesiology and Critical Care and Hyperbaric Medicine, Englewood Hospital and Medical Center, Englewood, NJ, United States}

^{f Pathology and Medicine (Hematology), Stanford University, Stanford, CA, United States}

^{g Transfusion Medicine, School of Medicine, University of Málaga, Málaga, Spain}

^{h Austrian Institute of Technology, Vienna, Austria}

^{i Department of Anaesthesiology, UniversitätsSpital Zuerich, Zürich, Switzerland}

Abstract

More than 30% of the world’s population are anemic with serious economic consequences including reduced work capacity and other obstacles to national welfare and development. Red blood cell transfusion is the mainstay to correct anemia, but it is also 1 of the top 5 overused procedures. Patient blood management (PBM) is a proactive, patient-centered, and multidisciplinary approach to manage anemia, optimize hemostasis, minimize iatrogenic blood loss, and harness tolerance to anemia. Although the World Health Organization has endorsed PBM in 2010, many hospitals still seek guidance with the implementation of PBM in clinical routine. Given the use of proven changemanagement principles,we propose simple, cost-effective measures enabling any hospital to reduce both anemia and red blood cell transfusions in surgical and medical patients. This article provides comprehensive bundles of PBM components encompassing 107 different PBM measures, divided into 6 bundle blocks acting as a working template to develop institutions’ individual PBM practices for hospitals beginning a program or trying to improve an already existing program. A stepwise selection of the most feasible measures will facilitate the implementation of PBM. In this manner, PBM represents a new quality and safety standard.

Keywords: Anemia, Blood loss, Blood transfusion, Hemostasis, Patient blood management.