Towards a systematic approach for (de)implementation of patient blood management strategies

SUMMARY
Despite the increasing availability of evidence in transfusion medicine literature, this evidence does not automatically find its way into practice. This is also applicable to patient blood management (PBM). It may concern the lack of implementation of effective new techniques or treatments, or it may apply to the (over)use of techniques and treatments (e.g. inappropriate transfusions) that have proven to be of limited benefit for patients (low‐value care) and could be abandoned (de‐implementation).
In PBM literature, the implementation of restrictive transfusion thresholds and the de‐implementation of inappropriate transfusions are described. However, most implementation strategies were not preceded by the identification of relevant barriers, and the used strategies were not often supported by literature on behavioural changes.
In this article, we describe implementation vs de‐implementation, highlight the current situation of (de)implementation in PBM and describe a systematic approach for (de)implementation illustrated by an example of a PBM de‐implementation study regarding ‘(cost‐) effective patient blood management in total hip and knee arthroplasty’. The systematic approach used for (de)implementation is based on the implementation model of Grol, which consists of the following five steps: the detection of improvement goals, a problem analysis, the selection of (de)implementation strategies, the execution of the (de)implementation strategy and a...

Source: Transfusion Medicine - March 6, 2018 Category: Hematology Authors: V. M. A. Voorn, L. van Bodegom ‐Vos, C. So‐Osman Tags: REVIEW Source Type: research