A Survey Of The Implementation Of Patient Blood Management In Medical Institutions In China

ObjectiveTo conduct a questionnaire survey on relevant personnel implementing patient blood management(PBM),in order to investigate the status of PBM implementation in different regions and different classed medical institutions.Find out the problems and seek solutions to accelerate the implementation of PBM in institutions,promote the rational use ofblood and better outcomes of patients.MethodsUsing the questionnaire software to make a PBM questionnaire and issue on WeChat platform,the URL is https://www.wenjuan.com/edit/preview/59a4ddf0d35780978fda6c71 Use Excel to entry and analyse data.Result1.GeneralTotally 814 questionnaires are received,786 are valid,and the ef-fective rate of the investigation is 96.56%.Respondents' medical institution classification:651(82.82%)respondents are from Class-3 hospitals,122(15.52%)respondents are from Class-2 hospitals,13(1.65%)respondents are from private hospitals.Respondents' profes-sional background:352(44.78%)respondents are from anesthesiology,146(18.58%)respondents are the head of blood transfusion manage-ment committees or from blood transfusion department,182(23.16%)respondents are from surgical departments(including neurosurgery,cardiovascular,orthopedics,thoracic,general,emergency,and gynecol-ogy department),52(6.62%)respondents are from internal medicine departments(including hematology and gastroenterology department),28(3.56%)respondents are from ICU,32(4.07%)respondents are from other departments(including oncology,pharmacy,medical,pediatrics,ultrasound,imaging,emergency,and infectious department).The ques-tionnaire covers 22 provinces,4 municipalities,and 4 autonomous regions in China in addition to the Tibet Autonomous Region,Hong Kong Special Administrative Region,Macao Special Administrative Re-gion and Taiwan Province.2.Understanding of the contents of PBM 704(89.57%)respondents choose "reduce the surgical bleeding",66(84.86%)respondents choose "autologous blood transfusion(ABT)",641(81.55%)respondents choose "improve the coagulation function,580(73.79%)respondents choose "restricted transfusion" and 536(68.19%)respondents choose "treating anemia".3.Treatment of anemiaThe department treats for anemia most is hematology(628,79.90%),and the least is geriatrics(311,39.57%).762(96.95%)respondents iden-tify the cause of anemia before red blood cells(RBC)transfusion.519(66.03%)respondents use iron as an alternative treatment for RBCs,most respondents(441,56.11%)use both intravenous and oral iron,and the department of hematology ranks the first in using in-travenous iron(530,67.43%).4.Measures to reduce bleedingMassive bleeding is the most abnormal bleeding treatment process has been established(588,74.81%).To detect coagulation function in pa-tients with bleeding,four coagulation test is the most commonly used(708,90.08%).470(59.80%)respondents choose thrombelastogram(TEG),anesthesiology(intraoperative)is the department that uses the most TEG(467,59.41%),the blood transfusion department provides TEG service most(332,42.24%).3(0.38%)respondents have never evaluated the patient's coagulation function before invasive procedures.8(1.02%)respondents have never actively treated coagulopathy.11(1.40%)respondents have never stopped taking antiplatelet drugs and anticoagulants before surgery.56(7.12%)respondents have never used controlled hypotension and other techniques to reduce bleed-ing.47(5.98%)respondents have never used antifibrinolytic drugs,such as aminocaproic acid and tranexamic acid.36(4.58%)respondents have never used local hemostatic drugs to stop bleeding.38(4.83%)respondents have never actively controlled iatrogenic blood loss.5.Restricted blood transfusion strategy(1)The purpose of blood transfusion:342(43.51%)respondents choose to supplement blood volume,79(10.05%)respondents choose to accel-erate wound healing;(2)59(7.51%)respondents rely on clinical experience to transfuse,including 38(10.80%)anesthesiologists.Only 10(1.27%)respondents choose the incidence of blood transfusion com-plications is extremely low and there is no need to worry.12(1.53%)respondents have never told the pros and cons of transfusion to patients.ABT is told to patients most as an alternative to blood transfusion(652,82.95%).6.Autologous blood transfusion(ABT)Cardiovascular surgery(514,65.39%)and orthopedic surgery(506,64.38%)take intraoperative blood salvage(IBS)most and the use of IBS is increasing(572,72.77%).7.Improve the tolerance to anemia17(2.16%)respondents have never took measures to improve tolerance to anemia.8.Blood transfusion process765(97.33%)respondents choose a consistent transfusion process has been reached in the institution.10(1.27%)respondents have never adopted individualized blood transfusion protocol for patients,606(77.10%)respondents choose the institution allows transfusion de-partment to refuse the application or ask for consultation.537(68.32%)respondents use the information system which supports the indication control when applying for blood transfusion.148(18.83%)respondents choose "the single minimum dose limit is not intended to be implemented".7(0.89%)respondents have never evaluated the patient" s efficacy after transfusion,23(2.93%)respondents choose the institution has never checked the transfusion case regularly.9.PBM training and implementation,factors limiting the implementation of PBM675(85.88%)respondents choose meeting as the most important way to obtain PBM knowledge,295(37.53%)respondents choose the institution has fully implemented PBM.138(17.55%)respondents believe that the conventional transfusion concept and the lack of awareness of PBM is the most important factor limiting the full implementation of PBM.Conclusion1.The proportion of fully implementation of PBM is still low in China,relevant personnel' s understanding of the contents and measures of PBM is insufficient.2.Relevant personnel pay more attention to reduce bleeding in PBM,the treatment of anemia is still neglected and the use of ABT is in-creasing.3.A consistent blood transfusion process can be reached in most in-stitutions,however,there is still room for improvement in mastering blood transfusion indications.4.The conventional blood transfusion concept and the lack of awareness of PBM is the most important factor limiting the full implementation of PBM.