The risks associated with blood transfusions in tandem with spiraling health care costs have placed the spotlight on blood management programs. In addition, Joint Commission on Accreditation of Healthcare Organizations performance measures related to blood utilization are expected in 2011. To meet these enhanced standards, centers with high surgical volumes will need to reexamine their transfusion practices.
To develop a comprehensive preoperative blood management program for the screening and manage anemia prior to elective noncardiac surgery with the goal of minimizing/avoiding blood transfusions and their associated risks.
Our institution has a state‐of‐the‐art blood management program supported with data benchmarking and education. Its preoperative component is based at the Internal Medicine Perioperative Center, which is staffed with hospitalists. The blood management program here is overseen by 3 medical directors and a nursing director. Patients with any of the following criteria are considered ideal for referral to the program: (1) suspected or known moderate–severe anemia, (2) high expected blood loss (EBL) based on the nature of the surgery, (3) requirement of multiple units of blood transfusions in recent surgeries; (4) patient‐exercised option for “no blood transfusion.” Based on these, referrals are initiated by the surgeon or hospitalists during the preoperative evaluation. Early referral is encouraged to allow sufficient time to schedule treatments and follow‐up. Subsequently, laboratory testing including iron studies, reticulocyte count, vitamin B12 and folate levels are obtained. The data are reviewed by 1 of the medical codirectors and a comprehensive treatment plan is laid out. Interventions involve targeted anemia treatments with intravenous or oral iron, vitamin B12, folate, or erythropoietin‐stimulating agents. The patient is also provided with education regarding sources of iron and the importance of adequate nutrition. Treatment and follow‐up testing are scheduled and communication provided to the surgical team regarding the progress of preoperative interventions and, if mutually agreeable, the need for additional time to continue optimization. In certain cases, the patients are followed postoperatively. Since its inception there have been more than a 100 referrals to the program. Because of impending surgery, intravenous iron has been the predominant treatment modality. Reimbursement restrictions to orthopedic surgery and black box warnings in cancer patients have precluded excessive use of ESAs. The Preoperative Blood Management Program in concert with newsletters, grand rounds, and an intranet portal, as well as a national blood management summit, is steadily working to change physician awareness and perceptions regarding perioperative transfusion practices.
Our preoperative blood management program with its aggressive anemia management is poised to significantly decrease blood utilization perioperatively.
M. Patel ‐ none; A. Kumar ‐ none; M. Benitez‐Santana ‐ none; M. Auron ‐ none