Page 103 - Hospital Authority Convention 2018

Masterclasses

M7.1 Patient Blood Management – from Overseas to Local Practices 16:15 Theatre 2

Patient Blood Management – Results from Australia and Leading Centres around the World
Hofmann A
School of Surgery Faculty of Medicine Dentistry and Health Sciences, University of Western Australia, Australia
From 2008 to 2012 the world’s largest Patient Blood Management (PBM) programme was implemented under the auspices of HOSPITAL AUTHORITY CONVENTION 2018
the Western Australia (WA) Department of Health. It was designed as a quality, safe and effective initiative with resource and
economic implications. The primary aim was to improve medical and surgical patient outcomes while achieving significant
cost savings by applying PBM principles.

The programme results were shown in a retrospective observational study including all emergency and elective adult acute-
care multi-day stay inpatient admissions (n=605,046) to the four major WA adult tertiary-care hospitals between July 2008
and June 2014. These hospitals perform majority of high-complexity procedures in the state including major trauma, burns,
and obstetrics referral services. Comparing final year with baseline, patient outcomes improved significantly: In-hospital
mortality was reduced by 28% (95% CI, 0.67 – 0.77; P<0.001), infection by 21% (95% CI, 0.73 – 0.86; P<0.001), AMI/Stroke
by 31% (95% CI, 0.58 – 0.82; P<0.001), and average hospital length of stay by 15% (95% CI, 0.84 - 0.87; P<0.001). At the
same time, blood product utilisation was reduced by 41% with product acquisition cost savings of AUD18.5 million and
estimated activity-based cost savings of AUD80 - 100 million1. Meanwhile, the Australian Commission on Quality and Safety
in Health Care made PBM a national priority and the National Safety and Quality Health Service Standards included PBM in
their system.

PBM programmes around the world are showing similarly good results in terms of outcomes and resource utilisation2,3.
Following the 2010 World Health Assembly Resolution 63.124, the European Commission is now also recommending the
implementation of PBM as a standard of care 5,6. On a global scale, the implementation of PBM has the potential to improve
morbidity and mortality for millions while saving health systems well above 100 billion dollars annually. Monday, 7 May 2018

M7.2 Patient Blood Management – from Overseas to Local Practices 16:15 Theatre 2

Patient Blood Management – Local Perspectives
Lie AKW
Department of Medicine, Queen Mary Hospital, Hong Kong

Blood transfusion is a well-established treatment modality to support many medical and surgical conditions which range from
simple to often complex procedures. Efforts in the past to ensure a safe, efficient and quality blood supply and transfusion
service have provided a very positive and reliable image to the general public and medical field alike.

Locally in Hong Kong, based on current trend, the potential demand for blood transfusion is expected to be continuously
increasing in coming years. This is due to an increasing and, particularly, aging population associated with expansion of
various areas of medical and surgical services. In recent years, there were repeatedly occasions where an adequate supply
of blood components was put to the test. While Hong Kong is an established hub for a large volume of interflow between the
East and the West, it is also very much exposed to the risk of an expanding array of transfusion-transmitted infection. This
puts pressure on the need and resources to ensure an adequate supply of safe blood components, potentially pushing up the
production cost of safe blood components.
To meet the above challenges, it is high time to encourage and develop a rational and evidence based practice of patient
blood management (PBM). Overseas experience has demonstrated that optimising transfusion activities is associated
with improvement in patient clinical outcomes, while at the same time reduce transfusion need together with cost saving
economically. As PBM involves significant culture and system changes, engagement of senior clinical and management
leadership together with education and promotion amongst every level of health staff is essential.

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