Patient Blood Management (eBook)

Hans Gombotz, Kai Zacharowski, Donat Rudolf Spahn (Autoren)

eBook Download: EPUB

2015 | 1. Auflage
280 Seiten
Thieme (Verlag)
978-3-13-258164-7 (ISBN)

Infos

Patient Blood Management (PBM) is an innovative clinical concept that aims to reduce the need for allogenic blood transfusions, cut health-care costs, and avert or correct the risk factors related to blood transfusion, thus minimizing the rate of side effects and complications. This comprehensive hands-on volume offers a three-point approach for the implementation of PBM to improve patient outcome, focusing on how to prevent or treat anemia, reduce blood loss, and increase anemia tolerance. The book also goes beyond preoperative PBM, with detailed accounts of coagulation disorder management and the administration of coagulation products and platelet concentrates.

Special Features:

• Presents a clear three-pillar strategy for the application of PBM: diagnosis and treatment of anemia, reduction of peri-interventional blood loss, and optimization of the tolerance to anemia in the everyday clinical setting
• Covers issues such as PBM during surgery, requirements for modern transfusion medicine, ordering blood products, the role of pre-anesthesia clinics, benchmarking processes, and potential implications of PBM in the public health sector
• Overview of research in PBM including landmark studies and current clinical trials
• Boxes in each chapter highlighting key information, core statements, and summaries
• A multidisciplinary and international team of contributors experienced in PBM

Patient Blood Management is a guide for clinicians and residents whose patients are at risk for anemia, coagulation disorders, or severe blood loss. Anesthesiologists, surgeons, and specialists involved in the use of blood and blood products can use the book for quick reference or to learn more about a leading-edge concept for optimizing patient safety and improving outcome.

Textauszug

Chapter 2 Practical Aspects of Preoperative Patient Management

2.1 Role of the Preanesthesia Assessment Clinic in Patient Blood Management

G. Fritsch

2.2 Role of the General Practitioner

J. Steinhaeuser, T. Kuehlein

2.3 Calculation of the Transfusion Probability—the Mercuriali Algorithm

P. H. Rehak

2.4 Ordering Procedures for Blood Products

A. Weigl

2.1 Role of the Preanesthesia Assessment Clinic in Patient Blood Management

G. Fritsch

2.1.1 Function of the Preanesthesia Clinic

The preanesthesia clinic is an integral part of modern anesthesia departments and hospitals. Its role is to provide information and to take charge of the medical optimization and risk stratification of patients undergoing a surgical procedure under anesthesia. This also explains its pivotal role in the perioperative sequence of events. Although reports on the first preanesthesia clinics date back considerably (Howland and Wang 1956), it was only in the 1990s that this approach was used on a broader scale (Fischer 1996). The perioperative medical optimization of patients in particular would be inconceivable without a well-functioning preanesthesia clinic. Only the preanesthesia clinic can guarantee the timely enrollment of patients in a PBM program, i.e., enrollment with a sufficient time reserve. This calls for close cooperation between diverse specialist disciplines, which is possible only when there is widespread acceptance of the preanesthesia clinic as an institution in its own right. The aims are to reduce the transfusion rates and to improve the general perioperative course of disease and the scheduling of operations.

2.1.2 Organization of a Preanesthesia Clinic

Patient Flow and Appointment Scheduling

Patient flow in the preanesthesia clinic is determined by several factors. These include the clinic times and the organizational procedures used by the referring departments on the one hand, and various circadian factors on the other. It is beneficial to assure a regular patient flow throughout the entire day. Patient satisfaction is closely linked to the amount of time—including waiting times—patients spend in the clinic. Therefore, the patient flow should be regulated such that waiting times are kept to the minimum, and that the ratio of contact time (consultation/treatment time) to waiting time is high (Edward et al 2008, Harnett et al 2010).

In principle, there are three models of appointment scheduling from which a preanesthesia clinic can choose:

• Appointments arranged in advance.

• No appointments, as in the case of a walk-in clinic.

• Combination of advance appointments and a system where a defined proportion of patients can present without an appointment.

Clinic with scheduled appointments. In a clinic with scheduled appointments, patients are seen only if they have been given an appointment in advance. This helps to better allocate personnel resources and integrate services into the clinical pathways (e.g., management of admissions or diagnostic pathways for certain indications), and to reduce waiting times. However, it requires effective operational time management. Often, such a system will not have the flexibility to receive patients at short notice. Moreover, smooth functioning of a clinic with scheduled appointments depends on the contact time of the patients. The more variable these times are, the more difficult it will be to adhere to the scheduled appointments.

Walk-in clinic. Compared with a clinic with scheduled appointments, a walk-in preanesthesia clinic that does not arrange appointments in advance faces certain drawbacks such as operational peaks and idle times when there is no patient contact, making it impossible to manage resources in a well-targeted and rational manner. Typically, peaks occur in the late mornings, when the highest patient throughput from referring clinics is expected. Naturally, these operational peaks mean increased patient waiting times and decreased patient satisfaction. The advantage conferred by a system that does not operate on the basis of fixed appointments is that it enables a certain amount of flexibility in scheduling appointments. This benefits patients who have to be integrated into the surgical schedule at short notice or because of an emergency.

Combination. An appointment scheduling system that combines the two forms described above can offer the advantages inherent in both systems while minimizing the disadvantages. In particular, a certain amount of flexibility in arranging appointments increases acceptance among the referring parties. The proportion of clinic visits available without appointment should be tailored to the total proportion of acute operations in the operating room schedule.

Generally, organizational interventions can have a positive influence on waiting times and contact times in the preanesthesia clinic (Edward et al 2010).

Note

Appointment scheduling is aimed at achieving patient satisfaction and optimizing resource utilization. Preference should be given to a combined system with a high proportion of fixed appointments and a certain number of freely available time slots.

Documentation and Administration

For administrative purposes, a preanesthesia clinic must be fully integrated into the hospital information technology system (HITS). This is essential because medical information, for example laboratory values and their progression over time, medical reports, and other medical history data, is required for the preoperative treatment of patients. Details of treatments received in, or suggested by, the preanesthesia clinic should be clearly documented in the HITS. Many of the current systems have facilities for the electronic allocation of appointments. This can greatly reduce the administrative effort.

A medical record must be maintained for each patient seen in the preanesthesia clinic. This should contain all the information needed for further preoperative measures, including any preoperative PBM optimization measures. The medical record should give a transparent overview of appointments, laboratory values, and treatment regimens (Table 2.1).

Human Resources Planning

Length of stay of patients. Planning of human resources for a preanesthesia clinic should be tailored to the patient flow, patient group(s) (comorbidities, age) seen in the clinic, and services rendered. This plan should strike a balance between patient throughput, medical care, and personnel workload. For mixed patient groups, an effective length of stay of 20–30 minutes per patient can be assumed. This does not include the waiting time. The physician contact time should be estimated at 15 to 20 minutes. The given time frames must be viewed as a guide only, and can be shortened or prolonged if justified. Parameters that help to predict the length of stay in the preanesthesia clinic include the number of long-term medications, the patient’s physical status according to the American Society of Anesthesiologists classification, and the patient’s age (Dexter et al 2012).

Table 2.1 Content of medical records in the preanesthesia clinic

Administrative information

Medical information

• Admission date • Examiner • Patient name • Date of birth • Patient identification number • Address • Other appointments

• Diagnoses and secondary diagnoses • Surgical procedure (including classification) • Allergies • Medical history • Clinical examination • Respiratory tract evaluation • Weight, height, body mass index • Risk indices, e.g., ASA score, Lee index • Premedication • Transfusion threshold • Other treatments • Other diagnostic measures

Abbreviation: ASA, American Society of Anesthesiologists.

Nursing personnel. Assuming that 25 patients per physician can be seen per day, this amounts to a throughput of approximately 6,000 patients per year. To achieve these figures, it is imperative that administrative tasks and medical diagnostic procedures be delegated to secretaries and nurses, respectively. There are marked differences in the range of professional activities entrusted to nursing personnel in various countries. For example, nurses in Austria and Germany are not authorized to engage in independent professional practice, whereas graduate nurses in the United Kingdom, the Netherlands, France, and Switzerland have much greater competencies. Therefore, it is not possible to give general recommendations for preanesthesia clinics. It should, however, be possible to achieve an optimum division of the workload in accordance with the legal regulations.

Medical specialist personnel. The qualifications required by the medical specialists who work in preanesthesia clinics are a matter of much debate in clinical practice. However, there is unanimous agreement that at least one anesthesiologist is required (ÖGARI 2012a). Important decisions such as the therapeutic measures to be taken for PBM should be left to the...

Produkt-Details

• Erscheint lt. Verlag: 10.11.2015
• Sprache: englisch
• Themenwelt: Medizin / Pharmazie ► Medizinische Fachgebiete
• Schlagworte: Blood Transfusion • Health-Care • Patient Blood Management • PBM
• ISBN-10: 3-13-258164-X / 313258164X
• ISBN-13: 978-3-13-258164-7 / 9783132581647