New Patient Blood Management Certification aimed at eliminating unnecessary transfusions

The Joint Commission and AABB (formerly the American Association of Blood Banks) have co-developed a new, voluntary Patient Blood Management (PBM) Certification based on the AABB’s Standards for a Patient Blood Management Program.

This program is the first recertification product that The Joint Commission has developed with an external organization. It provides a third-party evaluation of PBM programs. Certification is valid for two years, and the additional program is for hospitals and critical access hospitals currently accredited by The Joint Commission.

Purpose of PBM

PBM is an evidence-based, multidisciplinary program, which factors in all aspects of evaluation and clinical management surrounding the transfusion process, such as the application of appropriate indications, minimization of blood loss, and optimization of patient red cell mass.

The goals of the PBM certification program are to assist hospitals in implementing practices that eliminate unnecessary transfusions and adverse outcomes, ensure blood components are available for patients who truly need them, and create possible cost savings.

In October 2012, The Joint Commission and the American Medical Association convened an Overuse Summit, at which blood transfusion was listed as the most overused procedure in U.S. hospitals, costing billions of dollars. Transfusion also is the most common procedure performed during hospitalization; in fact, 11 percent of all hospital stays involving a medical procedure include a blood transfusion.

According to the U.S. Department of Health and Human Services, in “The 2011 National Blood Collection and Utilization Survey Report,” approximately 14 million allogeneic red cell units are transfused annually at a cost of more than $3 billion to hospitals, and 59 percent of red blood cell transfusions are inappropriate.*

Benefits of implementation

By implementing a PBM certification program, hospitals can achieve the following:

  • Improve patient outcomes
  • Reduce hospital stays, readmissions, and lengths of stay
  • Optimize care for those patients who may need transfusion
  • Foster collaboration throughout the hospital
  • Provide a competitive edge in the marketplace
  • Enhance staff recruitment and development

After implementing the PBM certification program, some hospitals have seen a 25 percent reduction in hospital stays for non-transfused patients over transfused patients, and the implementation of transfusion guidelines has been associated with a 47 percent reduction in the odds of death—as well as a 50 percent decrease in hospitalization costs after cardiac surgery. One hospital’s expenses went down approximately $510,000 just one year after implementation, according to a 2012 Clinical Leadership & Management Review article.

Examples of standards that are part of the PBM include the following:

  • Professional competency, which requires a hospital to define credentials for those health care practitioners who order or transfuse blood
  • Clinical guidelines, which requires the hospital to establish and define evidence-based PBM protocols for its population
  • Perioperative and pre-intervention patient care, which details requirements such as the maximum surgical blood ordering schedule and pre-procedure anemia management
  • Quality metrics and reporting requirements

For a free trial edition of the standards for the PBM certification program or an application, e-mail qualityhospitals@jointcommission.org. For PBM resources, visit the AABB website or the Joint Commission website.

Disclaimer

The thoughts and opinions expressed in this column are solely those of Dr. Pellegrini and do not necessarily reflect those of The Joint Commission or the American College of Surgeons.


*Shander A, Fink A, Javidroozi M, et al. Appropriateness of allogeneic red blood cell transfusion: The International Consensus Conference on Transfusion Outcomes. Transfus Med Rev. 2011;25(3):232-246.

Cole M, Walker T. Implementing a blood management program to improve patient safety. Clin Leadersh Manag Rev. 2012;26(1):20-27.

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