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MARCH 2019 

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Please consider making a donation to your Society. Your donations will help us to improve the lives of people throughout the world through Patient Blood Management.

SABM 2019 Newsletter Publication Schedule

March | July | November

Carolyn Burns, MD

Tiffany Hall, RN
Associate Editor

Sherri Ozawa, RN
Kevin Wright

Contributors for This Issue

Allison Jones, PhD, RN 

Becky Rock, RN

James Brown, MHA, CCP, LP

Seth Perelman, MD, FASA

Keck PBM Steering Committee 

Larry Burns, FACHE

Tamara Glover, MSc, CPHQ (on behalf of WA State Hospital Association) 

Carmen Melseth

SABM Officers and

© 2019 Society for the Advancement of Blood Management
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Phone: (928) 551-6400
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EMAIL: [email protected]

An Interview with SABM President - Pierre Tibi, MD

By Larry Burns, FACHE and SABM Advisory Director

Burns: My name is Larry Burns and I’m one of SABM’s new Advisory Directors. I’m here today to interview SABM President, Dr. Pierre Tibi. I’ve had the pleasure of knowing Dr. Tibi for the past 10 years. He introduced me to the concept of Patient Blood Management (PBM). As an administrator, you don’t often have something presented to you that improves patient safety, clinical outcomes, quality of care, and also saves money. Yet, that’s exactly what a PBM program does. It’s now been 5 years since we began the PBM Program at Yavapai Regional Medical Center in Prescott, Arizona. Dr. Tibi, what prompted your interest in PBM?

Tibi: Thank you, Larry. Basically, after my residency, when I started in private practice in Phoenix, my cases were few and far between. I was approached by a patient seeking “no blood” surgical care. He needed open heart surgery, he had consulted with several heart surgeons who had declined to operate on him simply because he refused to have blood transfusions. I agreed to perform his operation. It was not all that altruistic because I basically needed the work. I needed to figure out what I could do to increase the safety on a patient that refuses blood where normally 60-70% of patients who underwent heart surgery at the time were getting blood or blood products.

I thought about how to change the risk of requiring a unit of blood for patients undergoing cardiac surgery, some of these techniques we still use today. The most fundamental is just being a careful surgeon and very meticulous about any blood lost during surgery. Nevertheless, I operated on the patient and the patient did well. From that time forward, more patients were coming to me asking me to provide what they called “bloodless” heart surgery. Right about that time a fair amount of evidence was coming out that blood transfusions, contrary to popular belief, could be harmful to patients if it's not absolutely needed. This evidence prompted myself and the director of a hospital program in Phoenix, Richard Melseth, in 2003, to look at our results on hundreds of patients who had blood transfusions and those who did not. Our results mirrored the research - patients who were not receiving blood we're actually doing better than the patients who were receiving blood. It prompted us to ask the question, “why don't we apply this approach to everyone?” Our bloodless approach then expanded to applying PBM principles and techniques to all patients. Over the years that ensued, more and more research showed that avoidance of transfusion – especially when it's not absolutely necessary – correlates with decreased morbidity, decreased mortality and cost savings.

Burns: At Yavapai Regional Medical Center we were able to benefit from your early exploration, Dr. Tibi. We’re at over 2,000 open hearts right now. You might not expect open heart to be where you start a PBM Program. However, your leadership helped us implement PBM principles from open heart to orthopedic to general surgery. Can you talk about what your colleagues thought of PBM when it was introduced to them?

Tibi: By the time I arrived at YRMC, I was well on my way in my interest in PBM and using these skills routinely. Funny fact, I understand that the blood bank in Prescott was very concerned that we were going to start open heart surgery at YRMC because that would significantly increase the amount of blood stored and used. I was told that they had bought an extra refrigerator. We got here and after the first year I think we used 47 units of blood for the entire year which was on the order of 1% to 3% of the blood utilization for the hospital. Everyone was surprised that you could do heart surgery with minimal use of blood transfusion. The hospital administration then talked with me about applying PBM principles to many other areas or all areas of medicine. Blood transfusions were to be used in a much more stringent fashion, only where truly indicated.

We set up a PBM Program with Dale Black, also a SABM member, as the Director. We spoke with the different specialties about PBM and how the paradigm in regards to transfusions for treating patients had shifted. We backed that up with tremendous amounts of clinical data in research and we basically had to sell it. We sold it through education, we sold it through creating awareness not only to physicians but also the nurses and others that work in the hospital, as well as the community. This work continues to this day; every year we have a PBM event for the public where hundreds of patients attend. We stream it live where physicians and nurses can talk about their PBM experience. Patients who have directly benefited from the PBM Program speak. It takes a lot of work.


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Anesthesia & Analgesia

Consider submitting your future manuscripts in PBM for peer review and publication in this new section. The success of this endeavor will depend on the provision of material to make it lively and attractive to our colleagues and other professionals in the field.

Members Invited to Submit Papers CLICK HERE