Patient blood management has been defined as any intervention that helps decrease the patient’s chance of needing a blood transfusion during their hospital stay. Fairly liberal transfusion practice for anemic patients was the standard of care throughout the world. However, in the last decade there is evidence of many adverse outcomes associated with blood transfusion, especially when given during or immediately after a surgical intervention. The greatest predictor of whether a patient will need a transfusion is their preoperative hemoglobin level. The Holland Centre at Sunnybrook performs over 3,000 orthopaedic surgical procedures annually. In 2011, it introduced routine CBC (complete blood count) preoperative screening of all surgical candidates to identify anemic patients, manage potential anemia and refer high risk patients to the Blood Conservation Clinic for anemia optimization before surgery. All preoperative patients are given oral iron for one month. If patients are anemic, they are referred to the Blood Conservation Clinic (BCC) four to six weeks preoperatively for consideration of IV iron or Eprex. The project involved an interprofessional team that included Anesthesia, Hematology, Nursing, and Orthopaedic Surgeons. A preoperative blood conservation algorithm was designed and broad staff education was conducted. Patient education materials were also developed. Transfusion rates during the study period were 3.6% compared to 5.1% previously. The estimated cost-savings associated with fewer transfusions in this patient population was $75,000.
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