Anemia: Perioperative Risk and Treatment Opportunity

2021 ◽  
Author(s):  
Gregory M. T. Hare ◽  
C. David Mazer
Keyword(s):  
Patient Outcomes ◽  
Treatment Strategies ◽  
Adverse Outcomes ◽  
Perioperative Risk ◽  
Supplemental Digital Content ◽  
Digital Content ◽  
Patient Blood Management ◽  
Blood Management ◽  
Physiologic Responses ◽  
Improve Patient

Anemia is associated adverse outcomes in perioperative patients. Understanding the adaptive cellular and physiologic responses may help define the associated mechanisms and support utilization of effective patient blood management treatment strategies to improve patient outcomes. Supplemental Digital Content is available in the text.

scholarly journals A Programmatic Approach to Patient Blood Management – Reducing Transfusions and Improving Patient Outcomes

2015 ◽  
Vol 9 (1) ◽  
pp. 6-16 ◽  
Author(s):  
Shannon L. Farmer ◽  
Kevin Trentino ◽  
Axel Hofmann ◽  
James B. Semmens ◽  
S. Aqif Mukhtar ◽  
...  
Keyword(s):  
Patient Outcomes ◽  
Indirect Costs ◽  
Management Program ◽  
Transfusion Practice ◽  
Adverse Outcomes ◽  
Patient Blood Management ◽  
Blood Management ◽  
Economic Implications ◽  
Department Of Health ◽  
Comprehensive Health

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 indirect costs of blood, potentially severe blood shortages due to changing population dynamics, donor deferrals, loss of altruism, wide variations in transfusion practice and growing knowledge of transfusion limitations and adverse outcomes necessitate a paradigm shift in the management of anemia and blood loss. The concept of patient-focused blood management is proving to be an effective force for change. This approach has now evolved to embrace comprehensive hospital-wide Patient Blood Management Programs. These programs show significant reductions in blood utilisation, and costs while achieving similar or improved patient outcomes. The WA Program is achieving these outcomes across a health jurisdiction in a sustained manner.

scholarly journals Patient Education on Pre-operative Anemia: Using Character Animation to Promote Patient Activation

2019 ◽  
Vol 43 (2) ◽  
Author(s):  
Tracy Xiang ◽  
Katerina Pavenski ◽  
Shelley Wall
Keyword(s):  
Patient Education ◽  
Patient Outcomes ◽  
Public Awareness ◽  
Patient Activation ◽  
Character Animation ◽  
Patient Blood Management ◽  
Blood Management ◽  
Preoperative Anemia ◽  
Allogenic Blood ◽  
Improve Patient

Preoperative anemia affects up to 76% of the surgical population. One of the strongest predictors of allogenic blood transfusions (ABT), preoperative anemia is associated with worse patient outcomes including post-operative morbidity and mortality. Patient blood management (PBM) is a multidisciplinary program developed to address preoperative anemia and prevent unnecessary transfusions. Though PBM has been shown to reduce ABT and improve patient outcomes, many barriers to PBM implementation exist. Among these is patients’ lack of awareness and insufficient patient-centered educational resources that could improve patient activation.Previous studies suggest that character-driven stories are especially effective in sign-posting access to health resources among different demographics. However, due to production limitations and adherence to current motion graphic trends (e.g., whiteboard animation and text animation), character-driven stories tend to be neglected in patient education. We propose to develop a patient education animation focused on three representative preoperative anemia patients.  The narrative follows the characters’ health journeys from diagnosis to treatment, as we use a combination of 2D and 3D character animation, motion graphics, and data visualization to clarify some of the most common misconceptions and knowledge gaps around pre-operative anemia. We aim for the animation to achieve two main communication goals: 1) to educate all preoperative patients on the risk and benefits of blood transfusion; and 2) to improve public awareness of the Patient Blood Management Program (PBM), thereby increasing patient activation and enhancing preoperative care outcomes.Upon completion, this project will be the first character-driven educational animation addressing PBM. Evaluation of this project will provide further evidence of the effectiveness of character-driven storytelling in inspiring patient activation, which will enable more biomedical communicators to produce better patient-education resources.

Path to Action – Closing the Gap to Make Patient Blood Management the New Norm(al) as Viewed by Implementors in Diverse Countries

2020 ◽  
Author(s):  
Axel Hofmann ◽  
Donat R. Spahn ◽  
Anke-Peggy Holtorf
Keyword(s):  
Blood Loss ◽  
Research Training ◽  
Multidisciplinary Care ◽  
Adverse Outcomes ◽  
National Standard ◽  
Care Process ◽  
Patient Blood Management ◽  
Blood Management ◽  
Structured Interviews ◽  
Implementation Framework

Abstract Background: Patient Blood Management (PBM) is an evidence-based approach in surgery and emergency care which aims to minimize the risk for blood loss and the need for blood replacement for each patient through a coordinated multidisciplinary care process before, during, and after surgery. In combination with blood loss, anemia is the main driver for transfusion and an independent risk factor for adverse outcomes including morbidity and mortality. Hence, identifying and correcting anemia as well as minimizing blood loss are important pillars of PBM. 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 key observations extracted. By clustering the levels of intervention for PBM implementation, a PBM implementation framework was created and populated.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: This implementation framework helps to decompose the complexity of PBM implementation into concrete measures on each implementation level. It provides guidance for diverse stakeholders to independently initiate and develop strategies to make PBM a national standard of care, thus closing current practice gaps and matching this unmet public health need.

scholarly journals Intraoperative Hypotension Increased Risk in the Oncological Patient

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Islam Mohammad Shehata ◽  
Amir Elhassan ◽  
David Alejandro Munoz ◽  
Bryan Okereke ◽  
Elyse M. Cornett ◽  
...  
Keyword(s):  
Patient Safety ◽  
Patient Outcomes ◽  
Patient Population ◽  
Adverse Outcomes ◽  
Narrative Review ◽  
Medical Illness ◽  
Oncological Patient ◽  
Intraoperative Hypotension ◽  
Increased Risk ◽  
Improve Patient

: Patient safety advocacy involves avoiding, preventing, and amelioration of adverse outcomes or injuries caused by the process of healthcare rather than a patient's underlying medical illness. Intraoperative hypotension (IOH), a common morbid event, reduces perfusion to critical organs and tissues and has a wide incidence, depending on how it is defined. IOH has adverse intraoperative and postoperative consequences, which make its prevention important to improve patient outcomes. Certain populations have even greater consequences related to IOH, and clinicians must understand these risks. In this narrative review, we examine the risk of intraoperative hypotension in the oncological patient population.

scholarly journals Making patient blood management the new norm(al) as experienced by implementors in diverse countries

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Axel Hofmann ◽  
Donat R. Spahn ◽  
Anke-Peggy Holtorf ◽  
James Isbister ◽  
Jeff Hamdorf ◽  
...  
Keyword(s):  
Blood Loss ◽  
Research Training ◽  
Qualitative Content Analysis ◽  
Adverse Outcomes ◽  
National Standard ◽  
Care Process ◽  
Surgical Patient ◽  
Patient Blood Management ◽  
Blood Management ◽  
Implementation Framework

Abstract 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.

scholarly journals Call to Action – Closing the Gap to Make Patient Blood Management the New Norm(al) as Viewed by Implementors in Diverse Countries

2020 ◽  
Author(s):  
Axel Hofmann ◽  
Donat R. Spahn ◽  
Anke-Peggy Holtorf
Keyword(s):  
Blood Loss ◽  
Research Training ◽  
Healthcare Providers ◽  
Standard Of Care ◽  
Adverse Outcomes ◽  
National Standard ◽  
Patient Blood Management ◽  
Blood Management ◽  
Structured Interviews ◽  
Health Need

Abstract BackgroundMillions of hospitalized patients are anemic. However, anemia is an independent risk factor for adverse outcomes including morbidity and mortality. In combination with blood loss, anemia is the main driver for transfusion, thus adding risk for adverse outcomes. Patient Blood Management (PBM) is a concept to identify and correct anemia and to minimize blood loss. 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. By gathering the experiences of a diverse group of PBM implementors across countries with different healthcare contexts, we aimed to identify the drivers, barriers, measures, and stakeholders regarding the implementation of PBM. The synthesis of this information should provide a matrix of complementary measures, allowing PBM stakeholders from diverse professional backgrounds to initiate and orchestrate PBM implementation.MethodsSemi-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 were summarized per country, and key observations extracted. By defining the levels of intervention for PBM implementation and applying the Donabedian Quality Framework, we created and populated a matrix of key measures and outcomes as identified from the interviews.ResultsWe were able to extract a set of structural and procedural PBM implementation measures from interviews with the implementors. We created a matrix addressing six levels of implementation including government, healthcare providers (HCP), funding, research, training/education and patients and identified structural and procedural measures on each level. ConclusionThis matrix helps to decompose the complexity of PBM implementation into concrete measures on each implementation level. It provides guidance for diverse stakeholders to independently initiate and develop strategies to make PBM a national standard of care, thus closing current practice gaps and matching this unmet public health need.

scholarly journals Hyperglycemia and Acute Coronary Syndrome

2008 ◽  
Vol 109 (1) ◽  
pp. 14-24 ◽  
Author(s):  
Prakash Deedwania ◽  
Mikhail Kosiborod ◽  
Eugene Barrett ◽  
Antonio Ceriello ◽  
William Isley ◽  
...  
Keyword(s):  
Patient Outcomes ◽  
Treatment Strategies ◽  
Adverse Outcomes ◽  
Coronary Syndrome ◽  
Current State ◽  
Elevated Glucose ◽  
Coronary Syndromes ◽  
Short And Long Term ◽  
Poor Outcomes

Hyperglycemia is common and associated with markedly increased mortality rates in patients hospitalized with acute coronary syndromes (ACS). Despite the fact that several studies have documented this association, hyperglycemia remains underappreciated as a risk factor, and it is frequently untreated in ACS patients. This is in large part due to limitations of prior studies, and the remaining critical gaps in our understanding of the relationship between hyperglycemia and poor outcomes. The main objective of the present statement is to summarize the current state of knowledge regarding the association between elevated glucose and patient outcomes in ACS and to outline the most important knowledge gaps in this field. These gaps include the need to specifically define hyperglycemia, develop optimal ways of measuring and tracking glucose values during ACS hospitalization, and better understand the physiological mechanisms responsible for poor outcomes associated with hyperglycemia. The most important issue, however, is whether elevated glucose is a direct mediator of adverse outcomes in ACS patients or just a marker of greater disease severity. Given the marked increase in short- and long-term mortality associated with hyperglycemia, there is an urgent need for definitive large randomized trials to determine whether treatment strategies aimed at glucose control will improve patient outcomes and to define specific glucose treatment targets. Although firm guidelines will need to await completion of these clinical trials, the present statement also provides consensus recommendations for hyperglycemia management in patients with ACS on the basis of the available data.

scholarly journals 1377Did patient blood management guidelines reduce the rate of blood transfusion in pregnancy?

2021 ◽  
Vol 50 (Supplement_1) ◽  
Author(s):  
Heather Baldwin ◽  
Deborah Randall ◽  
Tanya Nippita ◽  
Siranda Torvaldsen ◽  
Jillian Patterson
Keyword(s):  
Interrupted Time Series ◽  
Adverse Outcomes ◽  
Transfusion Rate ◽  
Patient Blood Management ◽  
Blood Management ◽  
Interrupted Time Series Analysis ◽  
Management Guidelines ◽  
Critical Bleeding ◽  
Before And After ◽  
Future Work

Abstract Background Concern about increasing transfusion rates, adverse effects and increased costs have led to international efforts to reduce transfusion rates. Australian patient blood management guidelines were first introduced for critical bleeding in 2011, followed by obstetric guidelines in 2015. This study examines obstetric transfusion rates before and after the introduction of the critical bleeding and obstetric guidelines, accounting for pregnancy characteristics and prior trajectories. Methods Data were obtained from linked birth and hospital records from NSW between January 2002 and December 2017. Changes in raw and risk adjusted transfusion rates over time were investigated using interrupted time series analysis to assess changes in the trend in rate of transfusion among pregnant women with the introduction of each set of guidelines. Sensitivity analysis was performed to identify patterns in the data independently from the interventions. Results Data for 1,477,001 births in NSW from 2002 to 2017 were available for analysis. Preliminary analysis suggests the increasing rate of transfusion from 2002 was flattened after the introduction of the 2011 guidelines, with a significantly decreasing trend observed after the 2015 obstetric guidelines were introduced. Conclusions Patient blood management guidelines were associated with a reduction in the rate of obstetric transfusion in NSW. Key messages A focus on patient blood management was associated with an approximately 30% reduction in the transfusion rate, compared to the predicted rate, by the end of the study period. Future work will investigate whether this change in transfusion rates is associated with a change in rates of adverse outcomes.

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