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27/11/2020 - Covid-19

The importance of implementing a Transfusion Adjustment Programme in hospitals at the height of the COVID-19 epidemic

In five years, this project, promoted by the Hospital del Mar Medical Research Institute, has already reached around sixty hospitals in Spain

The MAPBM (Maturity Assessment Model for Patient Blood Management) project is a useful tool that helps hospitals evaluate and develop their programmes for managing the blood of each patient (better known as PBM or patient blood management). This has been highlighted in an article published in the journal Blood Transfusion, led by doctors from Hospital del Mar and researchers from the Hospital del Mar Medical Research Institute (IMIM).

PBM programmes are a set of therapeutic strategies, based on scientific evidence, aimed at improving the patient's condition prior to the surgical procedure, with particular focus on anaemia, minimising bleeding during surgery, and preventing or avoiding blood over-transfusion. They also have a direct impact by reducing the use of hospital blood reserves.

The application of Patient Blood Management models has been recommended by the World Health Organisation since 2010 and by the European Union since 2017, and is especially important at the current time, as the COVID-19 pandemic has led to a drastic reduction in donations and a decrease in reserves. Indeed, leading international experts in this field have appealed for models of this kind in an article published in the journal Anesthesia & Anelgesia. In Spain, this sentiment has been echoed in the Journal of Healthcare Quality Research, with regard to health management and policy proposals that promote the development of PBM.

Dr. Elvira Bisbe. Source: Hospital del Mar.

Nearly 200,000 episodes analysed

To facilitate the monitoring and internal evaluation of PBM programmes in centres, since 2015, the MAPBM evaluation model has been providing them with scores that allow them to chart their performance in this field. As pointed out by Dr. Elvira Bisbe, a consultant in the Anaesthesiology Service at Hospital del Mar, a researcher in the Perioperative Medicine and Pain Research Group at the Hospital del Mar Medical Research Institute (IMIM), and the main author of the article, "This allows them to assess how well they are doing and provides them with comparative data on each procedure so that they can identify where improvements need to be made, and link this to clinical results such as mortality and patient stays in hospital."

So far, 59 hospitals in Spain have joined the project, with other countries showing an interest in the results obtained. Nearly 200,000 episodes of 70 measures based on the structure of the centres, 14 key PBM performance indicators (KPIs), and another 7 for results have been analysed.  These are applied to 6 common surgical procedures, total knee arthroplasty, total hip arthroplasty, colon and rectal cancer surgery, heart valve surgery, hip fracture, and gastrointestinal bleeding. This allows the recommendations for the management of patient blood to be transferred to a series of key indicators that facilitate the implementation of improvements in hospitals.

Furthermore, the current pandemic situation caused by COVID-19 has created an environment where applying these practices has become even more relevant. "PBM and the MAPBM project are essential in COVID-19 times, due to the decreased number of donations, which makes the proper use of blood in hospitals crucial", explains Dr. Bisbe, who stresses that this involves a scarce and incredibly valuable resource with a limited storage life.

In fact, the Hospital del Mar has been awarded in the annual meeting of the participating hospitals in the Maturity Assessment Model in Patient Blood Management (MAPBM) project, held this November 27 virtually, in the category of Hospital without Cardiac Surgery with the best results in the MAPBM index, organized by the MAPBM Research Group and Vifor Pharma.

Reference article

Bisbe E, Garcia-Casanovas A, Illa C, Varela J, Basora M, Barquero M, Colomina MJ, González L, Hofmann A; MAPBM Working Group, Rodríguez LEF, Gosálbez AA, Fornet AP, Soler X, Planella T, Ricos P, Goterris R, Olmedilla L, Jericó C, Morales A, Gala JMG, Dueñas V, Fernández C, Tolos R, Villanueva MA, Cassinello C, Graciani IF, Aragon S, Subira M, Turcu V, Vilariño SAD, Zavala E, González LM, Moreno G, de Gracia SR, García A, Gallofre AP, Duque P, Sánchez LL, Vagace JM, Medina Á, Rodríguez MO, Faura A, Rosello L, Johansson E, Poch P, Santamaría MA, Rubio ML, Jara I, Carmona C, Lluch CR, Almirante M, López ÁF, Caldes M, Loureiro E, Quintana M, Azparren G, Puerta J, Romero EM, Rubio AA, Santaella J, Cerdan G, Arbones R, Palacios Á, Llamas P. Maturity Assessment model for Patient Blood Management to assist hospitals in improving patients' safety and outcomes. The MAPBM project. Blood Transfus. 2020 Sep 18. doi: 10.2450/2020.0105-20. Epub ahead of print. PMID: 32955422.

Other materials

Shander, Aryeh MD; Goobie, Susan M. MD; Warner, Matthew A. MD; Aapro, Matti MD; Bisbe, Elvira MD; Perez-Calatayud, Angel A. MD; Callum, Jeannie MD; Cushing, Melissa M. MD; Dyer, Wayne B. PhD; Erhard, Jochen MD; Faraoni, David MD, PhD; Farmer, Shannon MBS; Fedorova, Tatyana PhD; Frank, Steven M. MD; Froessler, Bernd MD, PhD; Gombotz, Hans MD; Gross, Irwin MD; Guinn, Nicole R. MD; Haas, Thorsten MD; Hamdorf, Jeffrey MD, PhD; Isbister, James P. MD; Javidroozi, Mazyar MD, PhD; Ji, Hongwen MD; Kim, Young-Woo MD; Kor, Daryl J. MD; Kurz, Johann PhD; Lasocki, Sigismond MD, PhD; Leahy, Michael F. MBChB; Lee, Cheuk-Kwong MD; Lee, Jeong Jae MD, PhD; Louw, Vernon MBChB, PhD; Meier, Jens MD; Mezzacasa, Anna PhD; Munoz, Manuel MD, PhD; Ozawa, Sherri RN; Pavesi, Marco MD; Shander, Nina BS; Spahn, Donat R. MD; Spiess, Bruce D. MD; Thomson, Jackie MBChB; Trentino, Kevin MPH; Zenger, Christoph PhD; Hofmann, Axel Dr.rer.medic; on behalf of the International Foundation of Patient Blood Management (IFPBM) and Society for the Advancement of Blood Management (SABM) Work Group Essential Role of Patient Blood Management in a Pandemic: A Call for Action, Anesthesia & Analgesia: July 2020 - Volume 131 - Issue 1 - p 74-85 doi: 10.1213/ANE.0000000000004844

Garcia-Casanovas A, Bisbe E, Colomina MJ, Arbona C, Varela J. Estrategias de gestión y política sanitaria para el desarrollo del Patient Blood Management en los sistemas de salud en España [Health policy strategies for Patient Blood Management implementation throughout the Spanish health systems]. J Healthc Qual Res. 2020 Sep 21:S2603-6479(20)30075-0. Spanish. doi: 10.1016/j.jhqr.2020.06.005. Epub ahead of print. PMID: 32972901; PMCID: PMC7505576.

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