Management of Patients With Critical Bleeding in Rural and Regional Victoria

The Australian National Blood Authority published 'Patient Blood Management guideline for adults with critical bleeding' in 2023, which includes a major haemorrhage protocol (MHP) template designed for adapting by individual health services based on local constraints. The extent to which regional and rural healthcare services adapt the national guidelines remains unknown. The aim of this study was to establish the current status of MHPs at regional and rural healthcare services in Victoria, determining strategies to align local MHPs with available resources and the best available evidence where variations to national guidelines exist.

Data on the existence and content of MHPs from all rural and regional healthcare services in Victoria that manage critical bleeding were collated. Consistency of the alignment of MHPs with national guidelines was assessed using a mixed-methods survey of experts.

All 58 regional and rural health services in Victoria were contacted; 33 (56.8%) had blood components available on site for the management of critical bleeding. Of these, 26 (78.8%) had an MHP. Seventeen (65.4%) MHPs had at least one domain that was not consistent with national guidelines. The availability of blood components other than red cells alone was associated with greater consistency with guidelines.

Despite strong recommendations that health services develop an MHP for the management of critical bleeding, some gaps remain. The contents of MHPs were variable, particularly for centres without blood components other than red cells, suggesting potential for the benefit of individualised review of MHPs and targeted education.