Hospitals and physicians have continued to face challenges in adopting evidence-based practice guidelines for RBC transfusions. In spite of the strong need to reduce RBC transfusions, existing tools for transfusion decision making may be lacking and this paucity may contribute to inappropriate transfusions. For example, estimated blood loss during surgery is often greater than actual blood loss, leading to incorrect assessments about the need for RBC transfusion and resulting in ‘over-transfusions.’\cite{hill2011accuracy} In addition, laboratory hemoglobin values, which are used as a primary indicator for RBC transfusions, are only available intermittently and are often delayed – leading to transfusion decisions without a laboratory hemoglobin value.(Frank 2012) In addition, repeated phlebotomies for laboratory tests are associated with induction and/or aggravation of anemia resulting in RBC transfusions in hospitalized patients.\cite{24138554,21824940} Technology to augment laboratory hemoglobin measurements, such as noninvasive and continuous hemoglobin monitoring, may provide clinicians with additional real-time trending information to determine if hemoglobin values are rising, falling, or remain stable, which may permit clinicians to make more informed and early RBC transfusion decisions.
It is estimated that the use of process changes and technology to reduce RBC transfusions can save the U.S. healthcare system in excess of five billion dollars per year, while significantly improving quality and safety.\cite{at27} Closing the performance gap will require hospitals and healthcare systems to commit to actions that will result in better healthcare outcomes with efficient use of healthcare resources. In the so far largest multicentre trial (almost 130,000 patients) in the world it has been shown that the implementation of PBM reduces significantly the amount of transfused blood, costs and kidney damage. Overall, the implementation of PBM is safe and effective.\cite{27163948}\ref{481903}
Leadership Plan
Based on sustained success of Patient Blood Management programs in USA, Australia, Europe, and Asia, proposals to implement change are listed below:\cite{27317382,27001367,20667328,23927725,24931841,24393629,24410741}