Patient-centered blood management.

Abstract

BACKGROUND: Transfusions are common in hospitalized patients but carry significant risk, with associated morbidity and mortality that increases with each unit of blood received. Clinical trials consistently support a conservative over a liberal approach to transfusion. Yet there remains wide variation in practice, and more than half of red cell transfusions may be inappropriate. Adopting a more comprehensive approach to the bleeding, coagulopathic, or anemic patient has the potential to improve patient care. METHODS: We present a patient-centered blood management (PBM) paradigm. The 4 guiding principles of effective PBM that we present include anemia management, coagulation optimization, blood conservation, and patient-centered decision making. RESULTS: PBM has the potential to decrease transfusion rates, decrease practice variation, and improve patient outcomes. CONCLUSION: PBM's value proposition is highly aligned with that of hospital medicine. Hospitalists' dual role as front-line care providers and quality improvement leaders make them the ideal candidates to develop, implement, and practice PBM.