Table 1.
Summary of the simplified recommendations with level of evidence (LoE) and consensus of recommendation (CoR)
| Recommendations | LoE | CoR (%) |
|---|---|---|
| 1. Comprehensive project management | ||
| Key leaders; involvement of stakeholders | C | 100 |
| Collection of PBM-related metrics | C | 90 |
| 2. Education program | ||
| Education initiatives; standard operating procedures, clinical protocols, visual aids, checklists; algorithms | C | 100 |
| Massive hemorrhage protocols; coagulation and transfusion algorithms | C | 100 |
| Online PBM e-learning course | C | 100 |
| Education at medical schools and hospital level | C | 100 |
| 3. Diagnosis and treatment of preoperative anemia | ||
| Preoperative screening, diagnosis, and treatment of anemia | B | 100 |
| Intravenous iron if oral iron is not tolerated or if surgery <4–6 weeks | B | 100 |
| Erythropoiesis-stimulating agents if nutritional deficiencies have been ruled out, corrected, or both | B | 100 |
| Elective surgery should be postponed until preoperative anemia has been classified and treated, if possible | C | 100 |
| 4. Reduction of iatrogenic diagnostic-/surgery-related blood loss | ||
| Avoiding unnecessary laboratory tests, lower frequency of sampling, using the smallest collection tube size | C | 100 |
| Closed in-line flush blood sampling devices for arterial (and central) lines | B | 100 |
| Appropriate cessation strategies for anticoagulation and antiplatelet therapy | C | 100 |
| Intraoperative approaches (meticulous hemostasis, minimally invasive surgery, laparoscopic surgery, diathermy dissection, physicians’ mindfulness regarding limiting blood loss, topical hemostatic agents) | B | 100 |
| Coagulation algorithm (preoperative assessment, ensuring basic conditions for hemostasis, reversal of anticoagulants, point-of-care diagnostics, optimized coagulation management, use of clotting factor concentrates) | B | 100 |
| Tranexamic acid | A | 100 |
| Autologous blood cell recovery (cell salvage) | A | 100 |
| 5. Optimal blood component use with patient-centered clinical decision support | ||
| Physician order entry with clinical decision support | B | 100 |
| Patient’s informed consent prior transfusion; hand-written/computer-generated forms with detailed outline of transfusion benefits, risks, and alternatives; information in discharge summary; patient’s own preferences | C | 80 |