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January 18, 2023

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Shifting Culture to Pioneer Effective Patient Blood Management (PBM) at a Florida Healthcare Facility

Case Studies

TeamHealth’s Anesthesia Performance and Innovations team partnered with a Florida healthcare facility to implement patient blood management (PBM) in the cardiac surgery service line. The innovative approach centers on patient safety and quality care while also enhancing facility operations and effecting positive change on resource utilization and clinical outcomes.

Partnership Information

  • Facility: A 199-bed acute care hospital in Florida
  • TeamHealth Services: Anesthesiology

The Challenge

Patients have the right to accept or decline medical care, and they may exercise this right for a number of reasons. Beyond a patient’s right to decline care, medical facilities should look closely at their approach to blood health and adopt a PBM program rather than remain committed to transfusion as their sole intervention. In contrast, current transfusion practice has a significant impact on hospital resources, including operational budgets. In addition to the economic burden, data collected over the past few decades have demonstrated that transfusion fails to treat the underlying condition of anemia and can adversely affect patient outcomes.

A subset of patients who seek up-to-date medical care but do not accept transfusion therapy are considered “bloodless” patients who have generally been rejected by clinicians thinking that blood transfusion was the only therapy available. Experience and data have demonstrated that these patients, treated by protocol and without transfusions, have done as well or better than those who are routinely transfused. This care has evolved to include all patients under the PBM concept and provide a single standard of care.

The Goal

To ensure the highest quality patient care and safety, the standards and skills to implement them must be consistent. In taking a new approach with PBM, TeamHealth and the facility aimed to standardize care and provide evidence-based protocols while also ensuring patient autonomy. One of the main goals of this approach is to treat anemia prior to surgery, which has an effect of lowering transfusion rates, reducing resource utilization and gaining substantial savings for the hospital. It is estimated that four out of ten surgical patients have some level of anemia. In fact, the World Health Organization (WHO) announced recently that anemia has reached a pandemic level, affecting almost three million patients worldwide. Anemic surgical patients are at four times higher risk of perioperative transfusion. This has a compounding effect, as the added treatment of transfusion is an independent risk that compounds the independent risk of anemia, increasing overall risk.

The Approach

The facility requested help in implementing a cardiac PBM program. This led to on-site visits with TeamHealth leadership and our renowned PBM experts as well as the hiring of a program coordinator by the facility to help advance the new approach. The facility chose to begin this work in their cardiac surgery service line first due to the existing high rates of transfusion. Bringing established PBM concepts and protocols by the TeamHealth group, the facility began work to shift the cultural reliance on transfusion to a patient-centered, evidence-based and multi-disciplinary approach that emphasizes reduced risk, improved patient safety and increased quality.

The medical community has a deep cultural rooting and reliance on transfusions in patient care. Overcoming this long-held entrenchment is a vital step in advancing the concept of a patient’s blood health. This requires culture shift, which necessitates strong collaboration, open communication and ongoing support. Furthermore, the program must show visible progress to help combat any reservations or misunderstandings about PBM and its impacts on patient care and hospital operations. TeamHealth was able to achieve this in close coordination with the facility’s leadership and benchmark reporting that showed the benefits for patients, the hospital, clinicians and the community.

The Evolution

Now that PBM is in effect, program members aim to build upon its initial success. First, the facility and TeamHealth will assist in establishing dedicated leadership for the program. Next, the team aims to add additional anemia screening and treatment prior to surgery for all surgical patients. This will reduce the overall risk of anemia and reduce a significant number of transfusions. The screening, diagnosis and treatment of anemia will be done on an outpatient basis, allowing unhindered hospital operations while also allowing for the proper code application for the care necessary to prepare these patients for cardiac surgery.

The Results

  • Increased volume for complex surgeries from zero baseline to 71 patients with no adverse events in cardiac patients from June – December 2022

The Conclusion

The goal of PBM is to improve patient outcomes through anemia management, optimized coagulation, blood conservation and patient-centered decision making. These improvements are made possible by the close collaboration and support across disciplines, resulting in facility realizes the benefits of improved clinical outcomes and operational performance, including substantial savings. TeamHealth offers structure, strategies and 24/7 clinical support to enact large-scale projects such as this at sites across the country. Reach out to our team to learn more about our clinical and operational services.

Download the full case study below to discover how we worked closely with the facility to shift culture and implement an effective patient blood management program to increase patient safety, clinical quality and resource utilization.