The practice of blood transfusion, introduced for the management of trauma before the 2nd World War, continued with little change until the last 15-20 years when there was an increase in literature suggesting perioperative transfusion with red cells was associated with increased mortality, morbidity, and mean hospital length of stay (LOS).
From financial years 2002-2003 to 2008-2009, total RBC unit issues to Western Australia (WA) rose 12% and were projected to continue rising largely due to the rapidly growing and aging population evoking concern regarding the long term sustainability of blood for transfusion.
In 2008, the WA Department of Health initiated a world first comprehensive health‐system–wide Patient Blood Management (PBM) program. The 5-year program received executive support and funding and was endorsed by the Australian Red Cross Blood Service. The program aim was “delivering optimal patient outcomes through the effective conservation and management of the patient’s own blood” and commenced at Fremantle Hospital as the pilot site.
The program was based on the three pillars of PBM, which provided a comprehensive framework for development including optimizing the red cell mass mass and coagulation status, minimizing blood loss and bleeding, and improving the patient’s tolerance to anaemia.
The aims in 2009 were to 1) develop and sustain a multi- disciplinary PBM program, 2) educate clinical staff about anaemia identification and management, 3) optimize haemoglobin (Hb) and iron stores for patients undergoing elective surgery, 4) reduce patient exposure to inappropriate RBC and blood product components, and 5) attempt to standardize transfusion practice.
From 2010 the program was extended to include all WA tertiary hospitals across medical and surgical specialities. From 2008 to 2014 the PBM program was associated with a decrease in mortality by 28%, a decrease in the infection rate by 21% and LOS by 15% with a reduction in red cell transfusions by 41%. Overall savings in blood products and associated costs were estimated to be AUD 80 -100 million.
Since 2015, when funding for implementation of PBM was discontinued, each of the tertiary care WA hospitals attempted to maintain a program which is now mandated by the requirements of the National Safety and Quality Health Service (NSQHS) Standards.
Overall the program has been effective: a surrogate for the effectiveness of the WA PBM program is the red cell usage in WA which declined from 32 to 19 per 1000 population between 2008 and 2018.