I am always amazed and interested at how events often occur in 3’s. If you are from Kentucky (or follow the “ponies”) you are likely familiar with the racing 3’s, aka the Triple Crown, of which the Derby is the opening event. There is also the trifecta which is defined as a successful bet for the top three winners in a race: win, place, and show. Well, I believe we have recently (and I might add, finally) achieved a trifecta for Patient Blood Management (PBM).
The trifecta of which I speak is the long-awaited and anticipated national recognition of PBM and thus, transfusion safety.
The first of the three events which initiated my designated trifecta was the American Medical Association and Joint Commission Overuse Summit which took place in 2012. Blood transfusions were recognized and listed within this committee’s top five over-utilized procedures/therapies. A complete discussion of the findings of this summit has been published on the Joint Commission’s website.¹
The second and equally important event was the soon-to-follow Choosing Wisely Campaign, sponsored by the American Board of Internal Medicine (ABIM) Foundation in 2013. Two of the top 5 recommendations pertain to PBM. Restrictive transfusion practices and minimizing overuse of laboratory testing which avoids iatrogenic blood loss anemia were both highlighted.² Several professional societies have embraced the Choosing Wisely Campaign and now have published specific recommendations for their own subspecialties. These include the American Society of Hematologists (ASH), American Association of Blood Banks (AABB), the American Society for Clinical Pathology (ASCP), and the American Society of Anesthesiologists (ASA). The list continues to grow. The American Hospital Association (AHA) has subsequently published a white paper mirroring these recommendations.³
And then the veritable “icing on the cake” has been the recent 2014 release of the AABB Standards for PBM.⁴ These standards place direct focus on the numerous distinct elements of a robust PBM program with levels of activity for all facilities/systems large and small. I imagine many of you have seen the May issue of the AABB News.⁵ This entire publication speaks to the integrated efforts of the ABIM, AHA and other groups that now have joined, in unison, the song of PBM.
Many of us have been beating the PBM drum for several years. Even those of you that are early in your “journey” are embracing it readily in your loco-regional arena. I applaud you! We should be pleased and proud that the drums have finally resonated with leaders of our nationally-recognized societies, accreditation bodies and medical professional groups. This will help to bring PBM and our mission for transfusion safety even more directly into the limelight.
I’m a good old Kentucky girl and I love to score a trifecta. This is a good one and it’s about time!
⁵AABB News, May, 2014; 16: 1-22
-Carolyn D. Burns, MD, is a Board Certified Pathologist who has worked as a medical director for transfusion services and an assistant clinical professor of pathology. She frequently speaks about topics such as transfusion reactions, transfusion in solid organ transplant, and anticoagulant/antiplatelet reversal strategies.