Patient Blood Management Implementation Strategies and Their Effect on Physicians' Risk Perception, Clinical Knowledge and Perioperative Practice - the Frankfurt Experience

Summary Introduction: A multicomponent, evidence-based and in- terdisciplinary Patient Blood Management (PBM) program was introduced at the University Hospital Frankfurt in July 2013. The implementation strategy included practical and tactical components aimed to increase knowledge on the risks of preoperative anemia, to standardize hemotherapy, and to facilitate PBM components. Methods: This article analyzes barriers to PBM implementation and outlines a strategy to introduce and manifest PBM. The effects in Frankfurt were measured in a before and after question- naire study distributed among groups of physicians imme- diately before and 1 year after PBM implementation. Re- sults: 142 clinicians completed the questionnaire in July 2013 and 101 clinicians in August 2014. Absolute certainty that the treatment of preoperative anemia favorably influ- ences morbidity and mortality rose from 25 to 37%. Trans- fusion behavior seems to have been affected: In 2014, 56% of clinicians stated that they clinically reassess the patient and analyze hemoglobin following each single red blood cell unit compared to only 38% stating this in 2013. Con- clusion: These results show that our implementation strat- egy was effective in changing physicians' risk perception, attitude, and knowledge on PBM principles. Our experi- ence highlights key success factors for the implementation of a comprehensive PBM program.