 Today we're going to be talking about a very important topic, patient blood management versus transfusion safety. So today I'm very happy to have Sherri Azawa with us today, a leader in patient blood management. Sherri, thank you so much for taking the time to be here with us today. All right, thank you for having me, it's a pleasure. Would you care to briefly introduce yourself? Sure, and thank you for the introduction already. So my name is Sherri Azawa, as you said. I am originally a critical care nurse by training, but I have spent the last 25 years in the field of patient blood management. Most of my career is spent at Englewood Health in Englewood, New Jersey, where we built probably one of the best known and largest patient blood management programs in the world. But for the last 20 years, also have been a founding member and a leader in the Society for the Advancement of Patient Blood Management, which is the only professional society dedicated fully to promoting optimal patient blood management as a standard of care for all patients. So currently president of that organization and very involved in really the promotion of patient blood management as a really important safety and quality initiative for patients worldwide. Wow, well, great. And again, we're so happy with us today. So I do have a few questions to ask you. So we'll kind of jump right into it. So patient blood management and transfusion safety are terms that clinicians often use interchangeably. So my first question for you is, what is the difference between patient blood management and transfusion safety? Well, so I'll start by saying, Sarah, that both are important. So certainly if patients are clinically in need of transfusion, we want that to be done safely. So there's no opposition between the two topics, but really patient blood management has a different focus. Patient blood management is really patient centered. So we spend a lot of time in the medical settings, even as citizens talking about blood and transfusion and the availability and the safety of blood and blood components. And patient blood management is in no way intending to attack that or disparage that. But really we spend a lot of time talking about the therapy, but really what is the disease? So patient blood management really focuses on what happens when a patient's own blood fails, anemia and bleeding and taking the best care of a patient's own blood. So for some patients, that might mean that a transfusion of blood components is indicated, but really for most patients, we're able to do many things to treat their anemia and bleeding and for blood conservation that we really contribute to an improved outcome. And transfusion may not even come up as part of the question. So they really are two very separate things though, related. Well, why is patient blood management often preferred to transfusions? And how could patient blood management programs reduce the number of transfusions? Yeah, it's really a really good question. And it's an important one because we want things that are really actionable and things that can be put into operation, right? By healthcare, individual providers and systems. And what is wonderful about patient blood management is that it really hits on some of the key quality and safety initiatives that are important to healthcare leaders throughout the world. So for example, taking good care of patients, anemia contributes to shorter lengths of stay to improve outcomes, to less complications if we treat their anemia both in the pre-hospital phase, just as an example. If we assertively treat bleeding appropriately and we are really on top of patients who are at risk for bleeding or when they are bleeding treating it with good goal directed therapy with good information, we know that their outcomes are better, that's almost obvious, right? But less death, less complications, better safety profiles, and actually less expense as well. So patient blood management really is a win-win for whoever's looking in any hospital system. If you look at it financially, from an outcomes perspective and a safety perspective, the most importantly, but really ultimately a better patient outcome from patient blood management. Well, my next question for you is, what are the components involved in implementing PBM programs reliably in an organization? Well, it's like so many things that require change. We're really, when it comes to patient blood management, we're really inserting the idea of evidence-based practice around anemia bleeding, coagulation of blood conservation in an area where people didn't really think much about it. So there can be real challenges. So the default position for so many providers for years has been transfusion fixes the problem, right? Transfusion fixes anemia. If the hemoglobin number is low, we can make it higher with the transfusion if the patient is bleeding. Maybe they need a different kind of blood component. And not to say that that's not still clinically indicated for some patients, but what we're really saying is in patient blood management is shift the focus back to the patient and their problem and use an evidence-based strategy to treat those problems. That seems very logical and almost common sense, but really in many of these cases, we haven't applied evidence to these areas. So in a practical sense in a hospital or a hospital healthcare system, we need to treat that impetus for change. Why is this important? What is the driver behind it? And because PBM, as we say for short, really attaches to many of the initiatives that institutions are looking at, like decreasing cost, like decreasing morbidity and mortality, decreasing infection rates, decreasing length of stay. It really answers all of those questions. It checks all of those boxes that we know that it's a win. How to make it happen though, sometimes it's a little harder, right? From the idealized picture that we might have to really make it something that and can transpire. So what we know in patient blood management programs that are successful is that there are both clinical and executive leaders who recognize the value of taking this approach, again for patient safety and quality. And that cultural change can be hard, but the ultimate achievement of a successful patient blood management program really is worth it. So we clinical leadership, executive leadership, and then clinical champions in a variety of different service lines or areas, particularly the ones we're bleeding in anemia and sometimes transfusion come up very often. So areas like critical care medicine, hospital medicine, anesthesiology, hematology and oncology, trauma surgery. These are places where patients are constantly facing these issues of anemia, bleeding, coagulation, getting those folks involved and really looking to the guidance of their own society. So it isn't just Sherry Ozawa and Savam and isolated people, their own organizations and the American Colleges of Surgeons, the American Society of Anesthesiologists can't list all these organizations, but so many of them have spent time and communication efforts through their choosing wisely campaigns or other types of communication to their members to say, this is an issue we really need to look at, right? The way that transfusions are used as a default to fix a number instead of really paying attention to what's going on with patients. And if we do that well, we really contribute to the right kind of outcomes that we want. So engaging those clinical champions is really critical. Also our nursing colleagues, important advocates in patient education and again, patient-centered decision-making, which is really the other pillar of patient blood management. And then the other piece is really helping to create an informed patient population where patients pay attention to their own health status, their own anemia. Almost a third of women of childbearing age are anemic, right? It's the most common medical problem in the world with two billion plus people affected, yet we just don't pay much attention to it either as individual women or men or patients, but our healthcare providers don't need it. It just sort of seems like a normal part of doing business. So educating both providers and patients that there are aspects to patient blood management taking care of your own blood or a patient's own blood that we could do much better. And thus ultimately make their outcomes when they do have a need for medical intervention or surgical intervention, safer and better. Or even if they don't, more vitality, more health, feeling better outcomes for their babies and their children. So that's just an example of anemia, but really it's a combination of an informed medical group of professionals and an informed patient population. Right, okay, interesting. Well, the last question that I have for you is what can interested audiences anticipate in the patient blood management realm in the next few months or even years? I know that there's a lot going on, but I wanted to get your feedback back on that. Yeah, well, it's a great question. And there's a lot going on around the world in patient blood management. It's very exciting to us who've been at it for a few decades. There are many countries and even continents in the case of Australia and the EU that have mandated in a positive sense patient blood management initiatives across countries or continents as important patient safety and quality initiatives. A number of other individual countries and health systems, certainly lots of hospital systems around the world. So a lot of the appropriate noise around patient blood management and movement by both, again, governmental health agencies, ministries of health, as well as individual hospital systems and providers and professional societies of all kinds. And what's also very exciting is within the next few months, there will be the release of a document outlining the urgency of the need and compelling the member states of the World Health Organization to implement organized patient blood management programs. So the World Health Organization will be releasing a very clear document that encourages all its member states to do something about patient blood management. It may look different. The implementation is going to be a little bit different from country to country depending on the culture and the assets and the resources, but everyone can do something, although it may look different in different places. No matter what level of economic development of countries out there are parts of patient blood management that can be quickly and easily implemented to the benefit of their population. So we're really excited about that World Health Organization statement. And we really think it's gonna be a strong strategy to impact people's minds around the world. That's so great. How exciting. Well, good. It sounds like there's a lot of great work that will be coming out and rolling out in the next few months or so. And I hope that this interview is very helpful for our intended audiences. But Sherry, before we wrap up, is there any final comments that you'd like to give to those that are watching? Just to remember that we are taking care of a precious resource, which is the patient's own blood, which is really a liquid organ, right? And we sometimes don't treat the blood when the endothelium combined really is the organ. We don't treat it that way. We treat it as maybe an IV fluid as healthcare providers, but it's a very precious resource, our own blood. The blood that generous people donate, right? As part of the donor system is also precious resource. But we and patient blood management really focus on what we do with our own blood and treating it as an organ system with the same amount of respect and with the same amount of specialization, same amount of research, the same amount of academic integrity when we look into how to treat it better. So just elevating that concept of what blood really is to where it belongs, it's our body's liquid organ and we need to treat it as something very precious. Well, Sherry, thank you so much. I can't thank you again for taking the time to speak with me today. And we hope that this interview is very helpful for our audiences. And we look forward to all of the great work that will be rolling out soon. Thank you, Sarah. It's been a pleasure to be here. Thank you.