Authors (including presenting author) :
Kong SY (1), Yip SF (2), Tsui KL (3)
Affiliation :
(1) Department of Medicine and Geriatrics, Pok Oi Hospital
(2) Department of Clinical Pathology, Tuen Mun Hospital
(3) Department of Accident and Emergency, Pok Oi Hospital
Introduction :
Patient blood management (PBM) is a patient-centred, evidence-based multidisciplinary approach to optimize red cell mass, minimize blood loss and better manage anaemia. PBM implementation has been shown to improve patients’ outcome and reduce transfusion-associated complications. Single unit transfusion (SUT) and restrictive transfusion strategy (RTS) are important PBM measures. The SUT rate in 2014 and RTS rate in 2019 were only 30% and 47.1-51% in NTWC respectively.
Objectives :
Through implementation of PBM in NTWC, we aim at
- Providing easy access to blood product usage key performance indicators for PBM stakeholders
- Reducing the number of blood transfusion
- Improving SUT and RTS rates
Methodology :
NTWC PBM subcommittee was established in September 2022 to facilitate and promote the implementation of PBM. The following parameters were periodically audited to guide the direction of PBM strategies in NTWC:
- The RTS rate from the Management Information Portal
- The SUT rate from the Clinical Data Analysis and Reporting System
- The blood product utilization rate from the Blood Bank System
- The iron (Fe) deficiency patient identification via the Laboratory Information System
At departmental level, PBM projects were carried out to tackle Fe deficiency in the following groups of patients with Fe deficiency by replacing Fe:
- Patients with menorrhagia in Departments of Accident and Emergency and Obstetrics and Gynaecology
- Oncological patients in Department of Clinical Oncology
- Patients undergoing colectomy in Department of Anesthesia and Operating Theatre Services
Result & Outcome :
At cluster level, the transfusion rate of NTWC (3.3-4.2%) was consistently lower than that of overall in Hospital Authority (3.8-4.6%) from 3Q21 to 2Q23. The red cell request remained static at approximately 5,100 units per quarter from 3Q22 to 2Q23 despite service expansion. The SUT rate of NTWC has improved from 30% in 2014 to 50% in 2021. The RTS rate of NTWC improved from 47.1% in 1Q19 to 72.6% in 2Q23.
At departmental level, PBM projects made a difference across various patient groups with Fe deficiency. The mean reduction of packed cell required per head reduced from 2.02 to 1.19 (p < 0.05) for patients with menorrhagia. Blood transfusion was fewer in overall oncological patients (1.1 ± 2.0 vs. 0.5 ± 1.0, p < 0.05) and hospice patients (1.3 ± 2.1 vs. 0.6 ± 1.0, p < 0.05) with PBM implementation. The number of patients with colectomy requiring transfusion reduced by 69% (p < 0.05) with iron replacement.
