Effectiveness of a multidisciplinary quality improvement initiative on perioperative morbidity using patient blood management strategies in a resource-constrained setting.

INTRODUCTION

Patient Blood Management (PBM) optimises patient outcomes by managing blood reserves and minimising transfusion needs. While its benefits are known, implementing PBM systematically is challenging, especially in resource-limited settings of low- and middle-income countries (LMIC). This study assesses the effectiveness of PBM strategies in clinical outcomes of perioperative patients undergoing elective surgery at a tertiary care hospital in Western Rajasthan, India.

METHODS

This two-phase prospective quality improvement study was conducted on patients undergoing elective surgery. Data were collected prospectively before and after PBM implementation from patient records, focusing on current practices including patient characteristics, preoperative hemoglobin levels, allogeneic blood transfusions, length of hospital stay, and requirements for ICU stay.

RESULTS

Among the 938 patients included in the study, implementation of PBM strategies resulted in an increase in preoperative hemoglobin levels from 11.94 to 12.3g/dL (P=0.011), hemoglobin at hospital discharge from 10.14 to 10.62g/dL (P<0.001) and a reduction in transfusion rates from 24.9% to 14.5% (P<0.001). The overall length of hospital stays decreased by approximately 48%, and there was a reduction in ICU admissions (21.6 to 12.6%) and duration of ICU stay (P<0.006).

CONCLUSION

Implementation of PBM improved patient outcomes, reduced transfusion needs, and optimised resource utilisation. The study emphasises the link between preoperative hemoglobin levels and length of stay, stressing the importance of managing anemia for better clinical results. These results underscore the value of multidisciplinary collaboration, education, and standardised protocols in achieving PBM objectives.