Sinai Health System
The transfusion medicine committee under the direction of Dr. Nadine Shehata plays an integral role in reducing blood transfusions in patients undergoing joint arthroplasty, gynaecology and high-risk obstetric services.
Transfusion Services met 100% of all standards with Accreditation Canada. We have submitted for Choosing Wisely Canada designation. The primary focus remains the management of preoperative anemia in hip and knee patients as defined by the Ontario Transfusion Coordinators (ONTrac) program supported by the Ministry of Health.
We work collaboratively with the transfusion medicine committee members including orthopedics, obstetrics and gynaecology, intensive care, general surgery, hematology, emergency medicine and anesthesia to review current practices, to reduce allogeneic blood transfusion and set up safe practices and procedures to manage required transfusions.
Toronto General Hospital
Under the guidance of Transfusion Medicine (Drs. Christine Cserti, Lani Lieberman, and Jacob Pendergrast) and with the support of the Ministry of Health, the Patient Blood Management (PBM) Program at TGH continues to grow and diversify. Blood transfusion has been added by Cancer Care Ontario as a quality indicator and this has prompted the hospital to support further our effects to reduce perioperative blood transfusions.
Sujung Yi, the nurse coordinator for the program continues to steer the preoperative patient assessment and treatment. The reported benefits of treatment immediately before surgery has dramatically increased the workload and patients are reviewed each day with one of 7 anesthesiologists assigned to the clinic: Drs. Justyna Bartoszko, Christopher Hudson, Alex Huang, Azad Mashari, Stuart McCluskey, Marcus Salvatori, and Marcin Wasowicz. Using EPIC and a closer collaboration with the surgical services, we are working on a strategy to improve the early identification of anemic patients so we can improve the effectiveness of our interventions e.g. EPO and intravenous iron. Surgeons are ordering baseline blood work at the time of listing for surgery and this blood work includes an assessment of iron status helping us to diagnose and treat anemia.
Blood management continues in the intraoperative period where point of care (POC) coagulation testing is used to guide transfusion practice and reduce blood loss as effectively as possible. The POC laboratory is managed by Arpita Kundu and overseen by Christine Cursio. It was recently moved to a site within the operating rooms allowing for more rapid clinical reporting. To support the increasing reliance of blood management in cardiac and transplant surgery on POC testing, teaching of fellows and residents has been expanded. The anesthesia assistants and perfusionists have also made great contributions to our efforts and their integrated knowledge of perioperative patient care has been especially important.
We will continue to develop the PBM Program as a perioperative patient optimization program and we will continue to be one of the premier programs in the country. We created 2 documents to keep the entire hospital aware of program i.e. PBM for Cardiac and PBM for Non-Cardiac Surgery. These documents are readily available to surgical teams. With the Quality Improvement Program of UHN, we plan to expand our efforts to every surgical department. The early focus of this work has been the Gynecology Oncology lead be Dr. Geneviève Bouchard-Fortier and Tiffany Tram, Quality Improvement Specialist, Anesthesia & Sprott Surgery.
Given the increasing need for intravenous iron, we work closely with the Medical Day Unit and the PMCC Ambulatory Care Unit to provide this important therapy. We have developed a process where we can accommodate the increasing demand of the PBM by coordinating the program and providing options for last minute infusions. Again working with the hospital, we are planning to add administrative support for outpatient intravenous iron therapy.
We are an active members of the Hospital Transfusion Committee and promote the clinical application of Hospital Transfusion policies. Our role as an intermediary between anesthesia, surgery, perioperative care and transfusion medicine is supported by the Sprott Surgery. We continue to lead the safe management of patients who have refused blood products, making sure patients and clinicians are appropriately informed.
The research arm of the PBM program continues to excel under the guidance of Drs. Justyna Bartoszko, Keyvan Karkouti, and Stuart McCluskey. We are currently assessing the effectiveness of our preoperative interventions (Iron PBM), the management of perioperative coagulopathy (The FARES Trial), the use of albumin and the need for postoperative iron therapy. A quality assurance initiative is looking at the timing of postoperative blood transfusions in order to better focus our efforts.
Toronto Western Hospital
The Patient Blood Management (PBM) program continues to maintain its integral role in reducing blood transfusions in patients undergoing joint arthroplasty, major spine surgery and oncology general surgery.
The primary focus remains the management of preoperative anemia in hip and knee patients as defined by the Ontario Transfusion Coordinators (ONTrac) program supported by the Ministry of Health. We continue to work collaboratively with the oncology general surgery team to expand the number of referrals in providing their patients with effective IV iron infusions preoperatively. Lucia Evans, the Patient Blood Management Coordinator is instrumental with the daily management of the Program.
