PBM Best Practices

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Reduce expenses while positively impacting clinical outcomes and patient safety.

Blood products are often one of the most expensive line items in the laboratory budget each year. Additionally, lab administrators are under increasing pressure to continue reducing expenses within the lab while maintaining quality. Understanding patient blood management (PBM) and what a world-class comprehensive patient blood management (cPBM) program entails can help laboratory administrators reduce expenses while having a positive impact on clinical outcomes and patient safety. There is a great opportunity for change in health systems across the country, and right now is the time to take advantage of the value and benefits that can result from implementation of a cPBM program.

For many hospitals, blood transfusion is the most common in-patient medical procedure and blood products are also one of the largest line items in a multi-million-dollar laboratory budget. Blood transfusions are also in high demand, expensive and can potentially lead to several serious medical complications. Patient blood management (PBM) optimizes the use of transfusion by ensuring that every blood product is given to the right patient, at the right time, in the right dose, for the right reason. A  comprehensive patient blood management (cPBM) is patient-centric, not transfusion-centric. A cPBM program also involves implementing proactive clinical strategies to reduce or eliminate exposure to blood products such as improving anemia recognition, diagnosis and management, and minimizing bleeding and blood loss. It is nearly impossible for a hospital system to effectively manage the complexities of PBM across the thousands of healthcare professionals in their system and the tens of thousands of patients in their care without a formal program in place. PBM is one of the most important patient safety initiatives in the United States this decade, according to Dr. Irwin Gross, a nationally recognized speaker and published author in patient blood management and transfusion safety.

Patient Safety Initiatives

PBM is quickly becoming recognized as one of the most important patient safety initiatives in the United States. Each year hospitals spend more than $30 billion on the acquisition of blood products and transfusion-associated costs and recent studies estimate that 40-60% of blood transfusions are unnecessary, excessive or avoidable.1,2 When hospital systems consider the high demand and value of blood products, the significant medical complications that can potentially result from transfusion, and the evidence indicating the overuse of transfusion, it becomes clear why implementing cPBM programs is such an imperative.

A world-class cPBM program ensures a consistent standard of care for all patients. Changing the entire culture within a large organization can be a daunting challenge, but focusing on several key strategies will achieve the best results. The following are five key components of a successful cPBM program:

  1. Program infrastructure and clinical champions are crucial to program success. Recommendations include implementing a PBM Steering Committee across a health system, multi-disciplinary PBM task force at all hospitals, and establishing an executive sponsor, physician champion and project leaders from nursing, lab and quality at each hospital.
  2. Evidence based transfusion guidelines and technology such as computer order entry and decision support to ensure consistent and accurate transfusion ordering. While many hospitals have transfusion guidelines, these are often vague, not up to date with current evidence, and may focus only on red blood cells (RBCs).
  3. Transfusion benchmarks and analytics to show each hospital, department and physician how they utilize blood products and how this compares to internal and external benchmarks.
  4. Broad education and awareness campaigns to permeate the organization with goals, objectives, and scientific rationale of the PBM program. These campaigns should not just focus on physicians but also include nursing and other ancillary hospital staff. The campaigns must also be ongoing throughout the implementation and maturation of the program.
  5. Focused performance improvement strategies designed to minimize or eliminate transfusion:
    1. Improve anemia recognition, diagnosis and management
    2. Minimizing bleeding and blood loss in high risk patients

Many hospitals today are in the process of implementing a blood utilization program or blood management program that focuses on a more evidence-based, restrictive approach to RBC ordering practices. These efforts to improve RBC ordering practices often yield 10-20% reductions in blood utilization and associated costs.  However, this is only one component of a cPBM program. cPBM programs focus on all blood products and include strategies designed to avoid transfusion. These programs often report 40%-plus reductions in blood utilization and blood acquisition costs, as well as improved clinical outcomes and overall reduced healthcare expense.

Real and Quantifiable Results

The most obvious measures of success for a cPBM program are the real and quantifiable results. Over three years, partnering with Accumen Inc., Sharp HealthCare’s cPBM program successfully saved millions of dollars associated with blood acquisition costs, preserved a precious community resource, and proactively reduced the risk of unnecessary patient exposure to blood products. Real results included over 6,000 patients avoiding exposure to blood products and a 30% reduction in overall direct blood product acquisition cost.

A Midwest health system with 14 hospitals saw similar results to Sharp HealthCare in regards to lowering costs and raising quality of care. After just 18 months, the system was transfusing 43% fewer RBC (patient volume adjusted), 17% fewer platelet transfusions and a $4.4M reduction in blood acquisition costs.

Implications for Laboratory Administrators

After implementation of a formal cPBM program, the lab will see reduced expenses associated with blood product acquisition and will also spend less time processing, storing and testing blood products. As cPBM is a clinical initiative supported by the lab, cPBM programs have also reported improved relationships with the clinical staff and increased visibility and credibility of the laboratory within the organization because of regular interaction with clinical staff and leaders.

The scope of most programs today is limited to improved RBC transfusion ordering practices. While this is a commendable start to any cPBM program, it is important to know that this is merely the beginning of the journey. Formal cPBM programs published in literature have reported 40-60% reductions in blood utilization and improved patient outcomes.3 A formal cPBM program provides real, quantifiable value to an organization, and should be a goal of all hospitals and health systems. Having an expert partner allows hospital systems to achieve real results.


References

  1. Shander A, Ozawa S, Hofmann A. Activity-based costs of plasma transfusion in medical and surgical inpatients at a US hospital. Vox Sanguinis. 
  2. Transfus Med Rev. 2011 Jul;25(3):232-246
  3. McKinney M. Reducing transfusions reduces patient risk at Main hospital. Modern Healthcare. 21 June. 2014.

Disclaimer: Accumen has no authority, responsibility or liability with respect to any clinical decisions made by—or in connection with—a provider’s laboratory, patient blood management, or other operations. Nothing herein and no aspect of any services provided by Accumen is intended—or shall be deemed—to subordinate, usurp or otherwise diminish any providers’ sole authority and discretion with respect to all clinical decision-making for its patients.

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Joseph Thomas, RN
Joseph Thomas, RN

Joseph Thomas serves as director, Patient Blood Management, at Accumen.

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