Measuring the Success of PBM in Practice – Lessons from Spain

According to the World Health Organisation, widespread implementation of patient blood management (PBM) programmes remains an urgent need.1 It is also important to evaluate how well they are working, says Elvira Bisbe (Hospital del Mar Medical Research Institute, Barcelona, Spain).


“Everyone in the audience will know how important patient blood management is to patients and to hospitals,” says Bisbe, speaking ahead of her talk at the Annual NATA Symposium. “The implementation of PBM programs can be difficult for hospitals because it involves changes in routine clinical practice that affect different specialties,” she adds.


“PBM is multidisciplinary and multimodal, you need to put many different departments in line,” Bisbe observes. Moreover, “it is important to measure what we do, if we want to improve our practice, and it is important to have different indicators of both process and results so that you can see if what you are doing really has an impact on patient outcomes,” she says.


During the ‘Looking in the Mirror’ session at the Symposium, Bisbe discussed her experience of measuring PBM implementation using the Maturity Assessment Model for PBM (MAPBM).2 This unique model has been championed in Spain over the past few years but its aim of “helping healthcare organisations to measure, benchmark, assess in PBM, and communicate the results of their PBM programmes,” has the potential to be used in other countries.3


The MAPBM model is essentially “a map of where you are, how far you can go, and what are steps to achieve that objective?” Bisbe says. Key to this is first looking at the structure of an organisation, she adds. “In order to change behaviour, it is also vital to know the degree of knowledge in PBM of the personnel that must be involved in the change.”


Examples of questions to ask when looking at PBM structure include “‘Do you have a special team for developing PBM?’; ‘Do you have protocols for the different pillars of PBM?’; ‘Do all the physicians in your hospital know about this type of programme and know the protocols?’,” explains Bisbe.


Next, the model looks at measuring specific indicators of the process from the three pillars of PBM. “So, we can measure the percentage of patients that receive pre-operative anaemia treatment, how many patients received tranexamic acid, what the haemoglobin trigger for the transfusion was,” and so on, explains Bisbee.


Finally, the third part of the model is to look at the effect on patient outcomes. This involves extracting data from hospital databases to see how many patients underwent a transfusion for a given procedure, for example, or how long did they stay in hospital, what was the overall morbidity and mortality?


“This is very powerful,” says Bisbe. “We can analyse if your hospital is prepared to implement PBM, we can analyse the process of PBM in different procedures in your hospital, and how this impacts the outcome to your patients.”


Each year MAPBM is used as a benchmarking tool in Spain, currently allowing 60 participating hospitals to see how they are performing in terms of their PBM strategies. Data are anonymised so only the hospital in question knows which data belongs to them.


Bisbe and colleagues have already published on the methodology of the MAPBM2 and will soon publish results from the benchmarking process. “We are going to have very interesting results very soon,” she says.


“The idea is if we improve PBM in our hospital, we can improve outcomes,” Bisbe notes. “Using the tool that we have developed will help hospitals to improve their own practice.”


  1. World Health Organization (WHO). The urgent need to implement patient blood management: policy brief. WHO: 2021. Accessed 16 April 2023.
  2. Maturity Assessment Model for Patient Blood Management website. Accessed 16 April 2023.
  3. Maturity Assessment model for Patient Blood Management to assist hospitals in improving patients’ safety and outcomes. The MAPBM project. Blood Transfus. 2021;19(3):205-215.

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