A Programmatic Approach to Patient Blood Management – Reducing Transfusions and Improving Patient Outcomes

Shannon L. Farmer1, 2, *, Kevin Trentino3, Axel Hofmann1, 2, 4, James B. Semmens2, S. Aqif Mukhtar2, Gareth Prosser1, 5, Jeffrey M. Hamdorf1, Sudhakar Rao6, Michael F. Leahy7, 8
1 School of Surgery, Faculty of Medicine, Dentistry and Health Sciences, The University of Western Australia, Australia
2 Centre for Population Health Research, Faculty of Health Sciences, Curtin University, Western Australia, Australia
3 Performance Unit, South Metropolitan Health Service, Perth, Western Australia, Australia
4 Department of Anesthesiology, University Hospital Zurich, Switzerland
5 Department of Orthopaedic Surgery, Fremantle Hospital, Fremantle, Western Australia, Australia
6 Trauma Services, Royal Perth Hospital, Perth, Western Australia, Australia
7 Haematology Department, Fremantle Hospital, Fremantle, Western Australia, Australia
8 School of Medicine and Pharmacology, The University of Western Australia, Australia

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Creative Commons License
© 2015 Farmer et al.

open-access license: This is an open access article distributed under the terms of the Creative Commons Attribution 4.0 International Public License (CC-BY 4.0), a copy of which is available at: This license permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

* Address correspondence to this author at the School of Surgery, Faculty of Medicine, Dentistry and Health Sciences, The University of Western Australia; E-mail:


In July 2008, the Western Australia (WA) Department of Health embarked on a landmark 5-year project to implement a sustainable comprehensive health-system-wide Patient Blood Management Program. Fundamentally, it was a quality and safety initiative, which also had profound resource and economic implications. Unsustainable escalating direct and indirect costs of blood, potentially severe blood shortages due to changing population dynamics, donor deferrals, loss of altruism, wide variations in transfusion practice and growing knowledge of transfusion limitations and adverse outcomes necessitate a paradigm shift in the management of anemia and blood loss. The concept of patient-focused blood management is proving to be an effective force for change. This approach has now evolved to embrace comprehensive hospital-wide Patient Blood Management Programs. These programs show significant reductions in blood utilisation, and costs while achieving similar or improved patient outcomes. The WA Program is achieving these outcomes across a health jurisdiction in a sustained manner.

Keywords: Anemia, blood conservation, blood loss, blood transfusion, patient blood management, bloodless surgery, practice change.