kirkaw

YAASSSSS! Dr. Issitt said that to me many times when I worked under his direction at Duke.

Greetings! After >10 years, we are updating our transfusion guidelines. (YAY!). Does anyone have a bibliography that they'd be willing to share, of articles from journals from specific medical disciplines, that advocate restrictive transfusion therapy? I'm looking for some kind of updated data akin to the TRICC trials. I think there have been recommendations from professional organizations such as anesthesia, critical care, cardiovascular and neurosugery, but I don't have the resources to do a full literature search. If you have ANY literature citations handy, I would be SO grateful for the input.

I would say, no because you have to verify electronic crossmatch per site. (This is according to Joint Commission.) I would also be wary of allowing them to store blood products there. You would certainly have to ensure appropriate monitoring.

This small hospital has been acquired by my hospital system. Would we still need a contract if they are part of the same hospital organization? Thanks.

I have learned that the small hospital we acquired has it's own CLIA number, so I am wondering how that will affect our decision. They are not going to have an ER but will be doing minor procedures. In envision the facility being much like a surgical center. And I know for a fact, that the other surgical center in our community does not have a blood bank/transfusion service.

Scott, Which Joint Commission Standards are you referring to and which CLIA regs? Thanks, Amelia

I love what I bought from ThermoScientific.

Greetings, We have acquired a very small hospital for which there will be limited services. The VP wants to terminate their full service transfusion service and only offer either 1) units for emergency release or 2) do all the pre-transfusion testing (including crossmatching) at our hospital and then transport crossmatched units to the smaller site or 3) both. I am curious to hear if any others have dealt with any of these scenarios and if so, point me towards the regulatory requirements for such a set-up. Thanks, Amelia

I have 2 related questions to this topic: Does anyone use and automated cooler validation kit, such as the Val-A-Sure kit? If so, how do you like it? How frequently do you validate your coolers? As an aside, we have deemed our coolers 'blood storage', as blood is likely to sit in them for hours in the OR without going anywhere. That seems more 'storage' than 'transport' to me.

Do you document the unit's temp when it is returned or is it assumed that if you indicate the the visual inspection is OK (or whatever 'check' your computer system requires) that the temp is <10?

I'd like to know how many people are using temp indicator devices on their blood units. We are currently using the HemoTemp II stickers on units that are put in coolers for the OR, but for all other 'routine' transfusions, we just have the '30 min rule', meaning that blood can only be out of the blood bank for 30 min. I have been approached by multiple vendors lately regarding temperature monitoring devices that attache to units, namely Saf-T-Vue and Blood Temp 10. What are people's experience with any of these devices? Do you apply them to all (blood) units or only those that are in a blood transport container like a cooler? Thanks.

Goodchild, we keep all the same reagents that you do except the Resolve panel C. Do you do adsorptions? We have a lot of warm-auto patients and that is the one thing we consistently have to send out. We keep an EGA kit too.

I like your thinking David. How long ago did you work at the smaller facility where you did all your own serology? I too, worked in a hospital where we did all that stuff, but it was the late 80's and early 90's before healthcare reimbursement went down the tubes. I really think I'm going to be asked to do a full scale cost analysis on this before attempting to bring all that testing in-house, and I was hoping someone else had done that in the past 5 years and could give me some ballpark estimates.

As I'm sure everyone else is doing, we are trying to find ways to cut costs. We are a medium sized hospital (<400 beds) in a rural setting without a trauma designation. Annually, I look at supplier contracts including reference lab testing. We currently do our own antigen typing and primary and secondary antibody ID panels but do not keep an enzyme panel nor do we do adsorptions, although we do perform elutions. Most of my staff are generalists and at least half of them are MLT's. I am curious to know the size of your institution and how much, if any, of your serology you send to a reference lab. We are seeing more complex patients (in volume, not necessarily complexity) and I am considering bringing in enzymes and adsorptions. Please give me your thoughts. Thanks!

We are a 4-hospital system with the same HIS but 3 of the 4 hospitals have different MRN's and all hospitals issue their own encounter # for each visit. We do have a unique blood bank identifier # that prints on the patient's armband that is the same across facilities and across visits. However, each time a patient is transferred to a different facility, we require that the receiving facility get a new type and screen specimen. The only time this is not true is for preadmit/pre-surgical patients. If a patient wants to have their blood drawn at a sister hospital because it's closer to their home, they can do so, but the specimen is collected and labeled with a handwritten label and the order is a paper requisition. Both of these items are delivered to the facility where the patient will have their surgery, a new encounter is registered, the type and screen ordered and the testing performed. The specimen remains at the testing facility where the patient is having surgery.