2021 Survey of Patient Blood Management

Patient Blood Management (PBM) is an evidence-based, multidisciplinary approach to optimising the care of patients who might need transfusion (Mueller et al, 2019). It was launched in England as a collaborative initiative in 2012 between NHSBT, NHS England and the National Blood Transfusion Committee (NBTC). PBM improves patient care by reducing unnecessary transfusion and promoting the use of appropriate alternatives to transfusion. This helps to ensure the availability of blood components for those patients where there are no suitable alternatives to transfusion.
An effective PBM programme needs leadership and support from national and regional leaders, hospital management, and health professionals, active education and training of the many staff involved in transfusion procedures in hospitals, and a robust programme of monitoring its implementation.
This is the fourth survey of PBM since 2013. The aim of the survey is to provide an overview of current PBM activity in hospitals, including the structure and resources in place to support the delivery of key objectives.
Participation in the survey enables hospitals to benchmark their practice nationally and against hospitals of a similar size and level of activity, enabling the production of a gap analysis for future business planning.

In September 2021, all NHS Trusts were asked to complete a survey about their PBM activity including delivery framework and governance arrangements. It was a companion activity to the national comparative audit of the implementation of the NICE QS138 Quality Standard (2016).

Although the response rate to this survey was lower than the three previous surveys, conducted in 2013, 2015 and 2018, the high response rate provides a good reflection of the national picture of the achievements of the Hospital Transfusion Teams (HTTs) and the challenges they face.
The priorities for HTTs remain largely the same: staff education to ensure safe and appropriate transfusion; management of anaemia including optimisation of patient’s haemoglobin concentration prior to surgery to reduce the need for transfusion; emphasis on the need to reduce wastage of blood components in clinical areas; and good stock management in transfusion laboratories.
Comparison of the findings from this survey with previous surveys indicates little or no improvement in the human resources available to Hospital Transfusion Teams to drive implementation of Patient Blood Management (PBM)
The provision of Transfusion Practitioners has remained stable in the last 6 years, but the workload demands have undoubtedly increased, and this may have led to an emphasis on maintaining the service rather than facilitating service improvements.
The survey indicates that Consultant Haematologists continue to have little time to support PBM.
Few HTTs indicate they are able to submit successful business cases for improvements in PBM activities, and cite lack of interest from senior management, lack of funding and their inexperience in assembling business cases as the main reasons.

Ensure the findings of this report are discussed at transfusion meetings in your Trust and with senior management.
Write an action plan and gap analysis based on the results and incorporate these into your objectives for this year. An important consideration is to understand what resources my Trust needs to implement better transfusion practice, for example to achieve compliance with the NICE Quality Standards for Blood Transfusion.
Use the data in the survey to promote your objectives within your organisation and explore the possibility of using the benchmark data to support business cases for further resources for PBM.
Continue efforts to engage with your Regional Transfusion Committee and discuss the potential of forming small working groups to support the development of key PBM objectives.