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Elora Thorpe, RN, MSN, has dedicated more than 20 years of her career to bloodless medicine and patient blood management (PBM). A member of the Society for the Advancement of Blood Management (SABM) since 1999, she served on the SABM board and chaired the first nursing arm of SABM, helping to translate the latest blood management science into evidence-based practice. She is passionate about its benefits and its role in the future of medicine. We caught up with her to find out how PBM is pushing the boundaries as an innovative way to approach transfusion and blood product utilization.
Elora’s career began as an ICU nurse at St. Luke’s Health System in Kansas City, where she saw how challenging it was for patients to receive appropriate care without blood. So, I read and learned as much as I could about bloodless medicine, and I met with our CNO and our COO and asked if they would be interested in starting a bloodless medicine program. They were forward-thinking and immediately said yes. Elora developed and led the patient blood management program there, then was recruited to develop and lead patient blood management at The University of Kansas Health System and make the same difference in quality, safety, and cost.
PBM is one of the few things where you can increase quality and safety and decrease costs at the same time. There's not a lot of things in medicine that you can do that with. If there's anything we know about patient blood management, it's that there is no one thing that makes a PBM program successful. It’s a combination of strategies – a comprehensive, multidisciplinary approach. You have to look at the big picture and always put the patient first.
Looking into the future of patient blood management
Our worldwide experience with COVID-19 is good evidence that as a nation, we need to develop a better plan and not solely depend on our dwindling blood supply as our only strategy to manage our patients as we have done in the past. There are good reasons to look ahead at the large amounts of evidence in the literature that teach us how to manage a patient successfully without a blood transfusion. Whereas other countries manage PBM from a government level, the U.S. healthcare system differs from hospital to hospital, or even physician to physician even within the same health system.
That much variation is just not a very good way to do it. Because that means if I happen to end up at hospital #1, I can't get the same care that I would get at hospital #2, that practices PBM strategies, simply because the ambulance, depending on my illness, may haves to take me to the hospital where I can receive the quickest care but does not have PBM. And for me, I think that those two standards of care for people in the U.S. is not a good thing. I don't think it's fair. And I don't think it's good medicine. Everyone should have access to PBM.
Elora’s vision for the future of PBM is a simple, yet ambitious focus on equity of access to comprehensive PBM: Every patient who is under our care deserves a comprehensive plan to mitigate their need for transfusion. If we can think of it that way, then it's really not a question as to who should be able to access this care and who should not be able to access this care. Everyone would receive the best care.. Currently, that's not how it works.
Pressing PBM knowledge and practice gaps
Despite comprehensive PBM standards set by the Society for the Advancement of Patient Blood Management, PBM is not given the same attention by every health system – and patients suffer as a result. It’s important to bring back an understanding of why high reliability organizations have systems and processes are in place, that force them to ask difficult questions, and to think about things in new ways, especially if the evidence suggests it’s warranted – as it is with PBM. PBM is rooted in a need to care for patients with anemia aggressively and differently. Anemia is no longer a “destination” or an end point. Elora advocates a broader understanding of PBM that spans the spectrum of the organization.
Anemia is the number-one health problem in the world, according to the World Health Organization. If we could fill that practice gap and get practitioners to understand that patients do better if they use PBM, that would be one of the greatest successes, I think, in this modern age.
To bring PBM to a health system, Elora said, you have to be aggressive. One surgeon I worked with used to put it very succinctly. He said, "If you want to do PBM, you have to bring your backbone." You have to be able to see what's possible. And sometimes in medicine, it's hard to see what's possible, because there's so many things muddying up the waters. But once you adopt it, you see the benefits, and then you're not so afraid.
Advice for health systems wanting to implement PBM
Elora’s advice to health systems that want to implement a comprehensive PBM program is first to learn as much as possible about PBM. When I first started, the reason it was so easy to start is because I had leaders who already had thought about it before I came along and were educated about the benefits to the organization. And I think that's why I was so impressed with how quickly that program started. It literally only took us five months to get started, which is unheard of in a health system.
Second, think of PBM as a service line or a Center of Excellence, like heart care or cancer care. A service line is designed to make the patient experience for a defined condition, patient-centered, where you are delivering high quality care, over the patient’s lifetime. So, care anywhere in the healthcare system, a service line makes sense because untreated anemia crosses the entire spectrum of care and adversely effects many conditions that a patient may have. PBM is that overarching term that focuses on various strategies and while it can include blood, blood is not the center of PBM.
Third is to put a team in place that approaches PBM by managing, planning and evaluating how the hospital performs. From optimizing the patient for surgery, providing high quality cancer care, or having an anemia program for kids. If you approach as you would any other service line, you will reap the benefits of it. And so, for hospital administrators, that's the part that they have to understand. To perform PBM correctly, it is no small task. It is a huge team of people executing a comprehensive plan that provides your patients the best care.
Envisioning a profound impact on healthcare
For Elora, she is guided by a strong vision of what's possible. We talk about that a lot in healthcare, but then we always ask, “Who else is doing it?” If you want to be the best at something, you don’t want to be second best, you have to be okay with creating it, and not putting it in place because everyone else has it in place. To have a profound impact on healthcare, you have to do something that's different. You can't be afraid to do that. You have to look at it and say, “I know in my heart, even in my head, that this is going to be beneficial for my patient.” And then you go ahead and do it.
Those are two different skills, Elora said. First, having the vision to profoundly impact healthcare by asking, “What if?” And second, having the commitment to follow through and create those things, make those changes. We're no longer satisfied with treating sickness and illness. We're now looking at preventing those things.