Our understanding of the risks associated with perioperative anemia and transfusion, in terms of increased morbidity and mortality, has evolved over the past 2 decades. By contrast, our understanding of the potential mechanisms of injury and optimal treatment strategies remains incomplete. As such, the important role of effective patient blood management (PBM) programs, which address both the effective treatment of anemia and minimizes the need for red blood cell (RBC) transfusion, is of central importance to optimizing patient care and improving patient outcomes. We report on important clinical outcomes of the Ontario Transfusion Coordinator (ONTraC Program), a network of 25 hospital sites, working in coordination over the past 20 years. Transfusion nurse coordinators were assigned to apply multimodal best practice in PBM (including recommended changes in surgical approach; diagnosis, assessment, and treatment of anemia; and adherence to more restrictive RBC transfusion thresholds). Data were collected on various clinical parameters. We further described lessons learned and difficulties encountered in this multisite PBM initiative. A significant reduction in RBC transfusions was observed for numerous indexed surgeries. For example, RBC transfusion rates for knee arthroplasty decreased from 25% in 2002 to 0.4% in 2020. For coronary artery bypass graft (CABG) surgery, transfusion rates decreased from 60% in 2002 to 27% in 2020. We also observed a decrease in RBC units utilized per transfused patient for knee (2.1 ± 0.5 [2002] vs 1.0 ± 0.6 [2020] units per patient) and CABG surgery (3.3 ± 0.6 [2002] vs 2.3 ± 1.9 [2020] units per patient). These reductions were associated with favorable clinical outcomes, including reduced length of hospital stay (P = .00003) and a reduced rate of perioperative infections (P < .001) for nontransfused versus transfused patients. These advances have been achieved with estimated savings in the tens of millions of dollars annually. Our experience and data support the hypothesis that instituting an integrated network of transfusion nurse coordinators can provide an effective provincewide PBM program, reduce RBC transfusions, improve some patient outcomes, and reduce health care costs, as an example of a “win-win-win” medical program.

在过去的 20 年里，我们对围手术期贫血和输血相关风险的认识，在发病率和死亡率增加方面发生了变化。相比之下，我们对损伤的潜在机制和最佳治疗策略的理解仍然不完整。因此，有效的患者血液管理 (PBM) 计划的重要作用是解决贫血的有效治疗和最大限度地减少对红细胞 (RBC) 输血的需求，对于优化患者护理和改善患者预后至关重要。我们报告了安大略输血协调员（ONTraC 计划）的重要临床结果，这是一个由 25 个医院站点组成的网络，在过去 20 年中协同工作。输血护士协调员被分配在 PBM 中应用多模式最佳实践（包括建议的手术方法改变；贫血的诊断、评估和治疗；以及遵守更严格的 RBC 输血阈值）。收集各种临床参数的数据。我们进一步描述了在这个多站点 PBM 计划中的经验教训和遇到的困难。在许多索引手术中观察到红细胞输血显着减少。例如，膝关节置换术的红细胞输血率从 2002 年的 25% 下降到 2020 年的 0.4%。对于冠状动脉旁路移植术 (CABG) 手术，输血率从 2002 年的 60% 下降到 2020 年的 27%。我们还观察到下降每个输血患者用于膝关节的 RBC 单位（2.1 ± 0.5 [2002] vs 1.0 ± 0. 每名患者 6 [2020] 单位）和 CABG 手术（每名患者 3.3 ± 0.6 [2002] 对 2.3 ± 1.9 [2020] 单位）。这些减少与良好的临床结果相关，包括缩短住院时间（P = .00003），并且非输血患者与输血患者的围手术期感染率降低（P < .001）。这些进步已实现，估计每年可节省数千万美元。我们的经验和数据支持这样的假设，即建立输血护士协调员的综合网络可以提供有效的全省 PBM 计划，减少 RBC 输血，改善一些患者的结果，并降低医疗保健成本，作为“双赢”的一个例子”医疗计划。