Implementation of a patient blood management optimization flowchart for preoperative anemia using automated alerts: An 8-month follow-up.

BACKGROUND AND OBJECTIVES: Preoperative anemia (PA) and thrombocytopenia (PT) are associated with increased perioperative morbidity and mortality. We implemented an automated flowchart integrating automated diagnostic reflex testing with electronic notifications to the preoperative unit (POU) triggered by hemoglobin (Hb) concentration <10 g/dL and/or platelet count (PLT) <75 × 109/L. MATERIALS AND METHODS: In this retrospective observational study, compliance and management of PA and PT were evaluated after routine implementation of the flowchart. RESULTS: The flowchart was initiated for 41 patients (1.5% of POU orders). Hb was 8-10 g/dL in 34 patients and <8 g/dL in four patients. Three patients had PLT <75 × 109/L with Hb >10 g/dL. At least one recommended action was undertaken in 88%, most frequently including documentation in the electronic medical record, communication with treating clinicians or referral to a hematologist. Etiology was established in 25 patients, with isolated iron deficiency as the most common cause of PA. Preoperative correction of anemia was performed in 26/41 patients and was primarily non-transfusion-based. Seven patients received transfusion therapy. Surgery was postponed in one case. CONCLUSION: A high compliance with the automated flowchart was observed and guided diagnostic and therapeutic interventions. Further optimization may improve standardized perioperative management of PA and PT.