Hematology Department, Fremantle Hospital, Fremantle, Western Australia, Australia; University of Western Australia, Perth, Western Australia, Australia.
Transfusion. 2014 Apr;54(4):1133-45. doi: 10.1111/trf.12362. Epub 2013 Aug 8.
We describe the implementation and impact of a patient blood management program (PBMP) in an Australian teaching hospital.
A PBMP was introduced at a single tertiary care hospital in 2009 as a pilot for the Western Australian Health Department statewide PBMP. The first 3 years of interventions aimed to make effective use of preoperative clinics, manage perioperative anemia, improve perioperative hemostasis, reduce blood sample volumes, and implement restrictive transfusion triggers and a single-unit transfusion policy.
Between 2008 and 2011, admissions to Fremantle Hospital and Health Services increased by 22%. Using 2008 as a reference year, the mean number of red blood cell (RBC) units per admission declined 26% by 2011. Use of fresh-frozen plasma and platelets showed 38 and 16% declines, respectively. Cryoprecipitate increased 7% over the 4-year period. For elective admissions between 2008 and 2011, the leading decline in RBC transfusion rate was seen in cardiothoracic surgery (27.5% to 12.8%). The proportion of single RBC unit use increased from 13% to 28% (p < 0.001), and the proportion of double units decreased from 48% to 37% (p < 0.001).
This is the first tertiary hospital in Australia to establish a multidisciplinary multimodal PBMP. Interventions across disciplines resulted in decreased use of RBC units especially in orthopedic and cardiothoracic surgery. Continuing education and feedback to specialties will maintain the program, improve patient outcomes, and decrease the transfusion rate.
我们描述了在澳大利亚教学医院实施和影响患者血液管理计划（PBMP）的情况。
2009 年，在一家三级保健医院试行西澳大利亚州卫生部门全州 PBMP 时引入了 PBMP。前 3 年的干预措施旨在有效利用术前诊所，管理围手术期贫血，改善围手术期止血，减少血液样本量，并实施限制性输血触发和单单位输血政策。
2008 年至 2011 年间，弗里曼特尔医院和健康服务中心的入院人数增加了 22%。以 2008 年为参考年，2011 年每例入院的红细胞（RBC）单位数减少了 26%。新鲜冷冻血浆和血小板的使用量分别下降了 38%和 16%。在 4 年期间，冷沉淀增加了 7%。2008 年至 2011 年间，择期入院患者 RBC 输血率下降幅度最大的是心胸外科（从 27.5%降至 12.8%）。单 RBC 单位使用率从 13%增加到 28%（p<0.001），双单位使用率从 48%降至 37%（p<0.001）。
这是澳大利亚第一家建立多学科多模式 PBMP 的三级医院。跨学科的干预措施导致 RBC 单位用量减少，尤其是在骨科和心胸外科。向专业人员提供继续教育和反馈将维持该计划，改善患者预后，并降低输血率。
