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![The 3-pillar 9-field matrix of perioperative patient blood management. The matrix was designed for the Western Australia Patient Blood Management Program to assist in the clinical implementation of the multiple PBM strategies. These strategies are considered in the perioperative period in a patient/procedure specific context. [Adapted from Hofmann A, Friedman D, Farmer S. Western Australian Patient Blood Management Project 2008-2012: analysis, strategy, implementation and financial projections. Western Australia Department of Health 2007; 1-154. Isbister has adapted this perioperative matrix for wider clinical application, for example medical/haematological patient populations (Isbister J. The three-pillar matrix of patient blood management. ISBT Science Series. 2015;10(Suppl. 1):286-94)].](profile/Shannon-Farmer/publication/276279631/figure/fig4/AS:667906698383379@1536252774499/Fig-2-The-3-pillar-9-field-matrix-of-perioperative-patient-blood-management-The.png)
The 3-pillar 9-field matrix of perioperative patient blood management. The matrix was designed for the Western Australia Patient Blood Management Program to assist in the clinical implementation of the multiple PBM strategies. These strategies are considered in the perioperative period in a patient/procedure specific context. [Adapted from Hofmann A, Friedman D, Farmer S. Western Australian Patient Blood Management Project 2008-2012: analysis, strategy, implementation and financial projections. Western Australia Department of Health 2007; 1-154. Isbister has adapted this perioperative matrix for wider clinical application, for example medical/haematological patient populations (Isbister J. The three-pillar matrix of patient blood management. ISBT Science Series. 2015;10(Suppl. 1):286-94)].
Source publication
In July 2008, the Western Australia (WA) Department of Health embarked on a landmark 5-year project to implement a sustainable comprehensive health-system-wide Patient Blood Management Program. Fundamentally, it was a quality and safety initiative, which also had profound resource and economic implications. Unsustainable escalating direct and indir...
Context in source publication
Context 1
... and communication strategies for both healthcare providers and consumers were developed, including an informative website (http://www.health.wa. gov.au/bloodmanagement/home/). Clinical education and perioperative clinical practice implementation was structured around a 3-pillar 9-field matrix of the multiple perioperative PBM strategies (see Fig. 2). Surgical hemostasis workshops were developed and run at the State's Clinical Training and Evaluation Centre (CTEC -http://www.ctec.uwa.edu.au) during the early part of the program to address the second pillar of PBM namely, reducing blood loss. PBM educational road shows were conducted at all major hospital departments to inform and ...
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Background: We compared the clinical outcomes of cardiac valve surgery in adult Jehovah’s Witness patients refusing blood transfusion to those in non-Jehovah’s Witness patients without any transfusion limitations. Methods: From 2005 to 2014, 25 Jehovah’s Witnesses (JW group) underwent cardiac valve surgery using a blood conservation strategy. Twent...
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Citations
... There are many minor and major complications like as allergic reactions, TRALI etc. of unnecessary blood transfusion. There have been many publications about the effects of transfusion on mortality, morbidity and the differences between clinicians' practices in recent years [21][22][23]. The limitation of our study is uninvestigating early and late complications of blood transfusion and anemia. ...
Objectives: Patient blood management (PBM) aims to improve patient outcome and safety by reducing the quantity of unnecessary blood transfusions and vitalizing patient-specific anemia reserves. We aimed to determine the efficiency and practicality of patient blood management in the cesarean section operating room in our hospital and the effects of the anesthesia method in cesarean section. Methods: Between 2019 and 2021, 6011 patients who underwent cesarean section were reviewed at Bursa City Hospital. Patients who received perioperative or postoperative blood product transfusion were divided into two groups as Group I (n=614) and patients who were not transfused into Group II (n=5397). Demographic data of the patients, preoperative hemogram laboratory values, performed anesthesia methods, transfusion rate were recorded from the database. Results: There was no statistically significant difference between the two groups in terms of demographic data (p>0.05). The preoperative anemia rate was 35.91% (n=2159) and in these patients the blood transfusion rate was 21.86% (n=472). Total transfusion rate was reported as 10.21% (n=614). Preoperative hemoglobin levels were statistically lower in Group I. The spinal anesthesia method was found to be statistically higher in both groups. Conclusion: Patient blood management is very important. In line with the guidelines on this subject, it will reduce unnecessary transfusions and therefore the risks of transfusion complications. In addition, considering the difficulty of supplying blood products, blood transfusion should not be considered primarily as a treatment. Anemia treatment should be planned before surgery and hemoglobin levels should be optimized. It is recommended to prefer regional anesthesia for PBM at cesarean section. In this way, we think that we will both increase the efficiency of patient blood management and reduce the cost and complications of blood transfusion.
... The year 2022 was still the year of COVID-19 pandemic but as of May 16 th 2022 the state of pandemic has been replaced by the state of epidemic emergency. Regardless of the context however, the basic factor that determines the availability of blood supply is still the good will of a sufficient number of volunteer, non-remunerated blood donors [5][6][7][8][9]. ...
... Szczegółowe zestawienie liczby składników krwi zniszczonych w poszczególnych CKiK w 2022 roku przedstawiono w tabeli 15, natomiast przyczyny zniszczeń składników krwi w CKiK w 2022 roku w tabeli 16. [5][6][7][8][9]. Ponadto zarówno w Polsce, jak w innych krajach, obserwuje się tendencję spadkową liczby osób zgłaszających chęć oddawania krwi; dotyczy to szczególnie niektórych przedziałów wiekowych. ...
... The year 2022 was still the year of COVID-19 pandemic but as of May 16 th 2022 the state of pandemic has been replaced by the state of epidemic emergency. Regardless of the context however, the basic factor that determines the availability of blood supply is still the good will of a sufficient number of volunteer, non-remunerated blood donors [5][6][7][8][9]. ...
... Irrespective of the context, the basic factor that determines the availability of blood supply is still the good will, and thus -a sufficient number of volunteer, non-remunerated blood donors [5][6][7][8][9]. ...
... In the section "Current problems of blood donation and transfusion medicine" we present some pandemic-related circumstances and the implications they may have regarding blood donation. Regardless of the circumstances however, the basic factor that determines the availability of blood supply is still the good will, and thus -a sufficient number of volunteer, non-remunerated blood donors [5][6][7][8][9]. ...
... Ten countries from Latin America, Central and Eastern Europe, Asia, Middle East and Africa were selected to reflect experiences from countries with different levels and types of healthcare resources and system (national/ private funders, public / private providers), and different developmental stages of Patient Blood Management (from early stage to more advanced). In addition, Australia was chosen as a reference country, where Patient Blood Management is adopted broadly and supported through public health authorities since 2008 and through National Patient Blood Management Guidelines since 2009 [15,48,49]. Likewise, a Swiss reference case was included, where Patient Blood Management is sustainably implemented across a leading hospital (University Hospital of Zürich). ...
Background:
Patient blood management (PBM) describes a set of evidence-based practices to optimize medical and surgical patient outcomes by clinically managing and preserving a patient's own blood. This concepts aims to detect and treat anemia, minimize the risk for blood loss and the need for blood replacement for each patient through a coordinated multidisciplinary care process. In combination with blood loss, anemia is the main driver for transfusion and all three are independent risk factors for adverse outcomes including morbidity and mortality. Evidence demonstrates that PBM significantly improves outcomes and safety while reducing cost by macroeconomic magnitudes. Despite its huge potential to improve healthcare systems, PBM is not yet adopted broadly. The aim of this study is to analyze the collective experiences of a diverse group of PBM implementors across countries reflecting different healthcare contexts and to use these experiences to develop a guidance for initiating and orchestrating PBM implementation for stakeholders from diverse professional backgrounds.
Methods:
Semi-structured interviews were conducted with 1-4 PBM implementors from 12 countries in Asia, Latin America, Australia, Central and Eastern Europe, the Middle East, and Africa. Responses reflecting the drivers, barriers, measures, and stakeholders regarding the implementation of PBM were summarized per country and underwent qualitative content analysis. Clustering the resulting implementation measures by levels of intervention for PBM implementation informed a PBM implementation framework.
Results:
A set of PBM implementation measures were extracted from the interviews with the implementors. Most of these measures relate to one of six levels of implementation including government, healthcare providers, funding, research, training/education, and patients/public. Essential cross-level measures are multi-stakeholder communication and collaboration.
Conclusion:
The implementation matrix resulting from this research helps to decompose the complexity of PBM implementation into concrete measures on each implementation level. It provides guidance for diverse stakeholders to design, initiate and develop strategies and plans to make PBM a national standard of care, thus closing current practice gaps and matching this unmet public health need.
... The surgeon always explains the stages of the plan, from the preoperative preparation to the postoperative period, taking time to describe the operation procedures and the options for managing the risk of potential acute anemia due to intra-or postoperative hemorrhaging. The fact that patients are informed of the strict adherence to the indications provided in the Patient Blood Management (PBM) program regarding the potential for surgical operations to be performed without the use of blood transfusions enables patients to express their wishes in correlation with a precise program [23][24][25][26][27]. PBM is explained, in more or less detail depending on the patient's knowledge, in accord with the SIAARTI (Italian Society of Anesthesia, Analgesia, Resuscitation and Intensive Therapy) definition: "a multidiscipline, multimodal and personalized approach to reduce or eliminate the need for transfusions of allogenic blood through management based on the signs of anemia, reducing blood loss and optimizing blood salvage strategies". ...
Background:
On 22 December 2017, Law No. 219 was approved in Italy. This law provides citizens with effective tools with which to express healthcare decisions: namely, advance treatment directives (ATD) and shared care plans (SCP).
Methods:
This article presents an analysis of 70 SCP cases carried out in a tertiary hospital in Italy during the period between 01.02.2018 and 29.02.2020 inclusive.
Results:
In 90% of cases, the objective of the plan pertained to situations regarding patients' refusal of transfusions of blood components, the majority (97%) due to their belonging to the religious movement of Jehovah's Witnesses. 46% of the sample had drafted ATDs. The course of treatment recommended by the attending physicians was confirmed in 93% of the SCP cases. Trustees were appointed in 96% of cases. In 55% of cases, patients assigned trustees with attestative functions and the remaining 45% with creative functions. The results demonstrate that each patient personally dictates his or her wishes and the role assigned to the trustee. SCP meetings serve as a useful tool for providing the patient and his or her relatives with information, and for appointing a trustee. However, it has never been necessary to solicit the intervention of the trustee following a surgical operation.
Conclusions:
The SCP has proven to be an essential tool in achieving the objective of personalised medicine. However, there is still notable passivity in its application. Further effort is required in order for it to become a common asset in clinical practice.
... Concerning blood transfusions, the implementation of Patient Blood Management [15], even though the introduction of guidelines developed by the National Blood Centre [16], represents a revolutionary scientific element [17] that will greatly limit the use of allogeneic transfusions, reducing their risks and conflicts between physicians and patients who refuse them. ...
Introduction: Clinical legal medicine is a branch of legal medicine that takes place in a clinical setting approaching the patient's bedside and using a particular attention not only for conceptual or normative references but also for every possible medical and social aspect.
Material and methods: The requests of medico-legal opinions received by the Department of Legal Medicine of a large university hospital were retrospectively collected over a 5-years period. The analysis focused on the recurrence rate of the requests and the most common medico-legal issues to be solved in a clinical context, differentiating between adult and minor patients.
Results: The collected medico-legal advices amounted to 448. The most clearly involved clinical area was Medicine (54%) followed by Gynecology and Obstetrics (15.6%), Pediatrics and Surgery (10.7%). The requests concerning patient's self-determination in therapeutics choices, including refusal of proposed treatments, covered almost one-half of total casuistry. The designation of support administrator represented also a relevant issue (20.5%). In case of minors, the queries related to reporting crimes were three times higher than in adults, while the appointment of a support administrator was never requested.
Conclusion: Clinical legal medicine, through medico-legal advices, plays a primary role in contributing to the safeguarding of health and to the decision-making process of clinicians.
... This is brought about by advancement in various fields of medicine as well as other factors such as the aging of societies. Therefore, the basic factor that determines the availability of blood supply is still the good will, and thus -a sufficient number of volunteer, nonremunerated blood donors [6][7][8][9][10]. ...
