The Western Australian Department of Health approved a 5-year project in 2008 to implement a system wide Patient Blood Management (PBM) programme. At that time WA had the lowest red blood cell transfusion rate in the developed world. However, total RBC, fresh frozen plasma and platelet units issued to the State were increasing and a large body of literature was emerging demonstrating transfusion as a dose-dependent risk factor for adverse patient outcomes. Studies also showed that the establishment of hospital-based PBM programs resulted in improved outcomes and reduced costs.
Implementation strategies addressed each of the three principles of patient blood management (anaemia and iron deficiency, blood loss and transfusion thresholds) across the three key timings in the patient journey: pre-operative, intra-operative and post-operative.
Symposia were convened and surgical workshops developed to assist clinicians with their understanding of the principles behind PBM. Data pertaining to various aspects of care as well as patient outcomes aided in informing change.
At the conclusion of the programme the following key results have been identified: 28% reduction in hospital mortality, 15% reduction in average hospital length of stay, 21% decrease in hospital-acquired infections, and 31% decrease in the incidence of heart attack or stroke. In addition to this the program promote a reduction in the use of blood products by 41%, representing a cost saving of $18.5 million to the health system. Gross savings, which included costs associated with administering transfusions in the hospitals, were estimated at $80-100 million.
Importantly the principles of PBM appear to have become embedded into a patient-centred care system.