No Patient Registration

[KRIS]

Hello, I am working in a small town hospital. I want to ask your opinion about this scenario. Patient stay in the ambulance and took by airmed. ER doc, requested blood and took by Airmed personnel. All documentation in paper, blood charges in paper. Patient not registered that day and no visit number .Is this accepted? or its a deviation?

We are using Meditech in our facility but for this case patient has no registration number. 

appreciate all your response

[Ensis01]

I have seen something similar once; if I remember correctly the BB kept track of the patient to confirm which hospital they went to, ensured the paperwork went to to our registration, who registered the patient and the BB then issued the uncrossmatched RBCs in the LIS.

I do not believe there was a deviation as you have documented orders from an ER doc for uncrossmatched RBCs.

[BankerGirl]

In this scenario, we would do as Ensis01 stated as long as the blood was not transfused in route.  If it was transfused, you may have difficulty getting the receiving hospital to accept this.  Then I believe you would have to have the patient registered, even if just as a John Doe, and perform an emergency issue in Meditech.

[John C. Staley]

I hate to be the mercenary here but who's going to pay for it??  Probably going to be one of those "cost of doing business" things.  

[Ensis01]

On 10/23/2021 at 9:24 AM, John C. Staley said:

I hate to be the mercenary here but who's going to pay for it??  Probably going to be one of those "cost of doing business" things.  

In the case I described above; the patient was retrospectively registered and the units issued and billed to them. My understanding was the hospitals, ambulance and police all had good communication, cooperation and shared all the information to treat the patient efficiently in unusual circumstances. 

[BankerGirl]

On 10/23/2021 at 8:24 AM, John C. Staley said:

I hate to be the mercenary here but who's going to pay for it??  Probably going to be one of those "cost of doing business" things.  

John, I agree that reimbursement may not be always be realistic, but for documentation purposes it would be advisable to have even a basic registration and document the transfusions.  

[John C. Staley]

This does provide for an interesting dilemma and discussion.  How do you register and bill a patient who never entered the facility?  What is your facility's relationship with the transport companies?  Are they owned and operated by your facility? Do you have a formal contract with them that includes providing blood products?  These are just a few of the questions that come to mind.  I have no problem with what anyone did in this scenario but I do wonder what a few of the various inspectors / assessors I encountered over the years would have to say about it.  I'm not a big proponent of living in the world of "what if" but it can be interesting to visit there once in awhile.

[Ensis01]

While I am not an auditor; I would assume that from an auditor's perspective a hospital not being able to show the tracking of how, where, when and why a unit of blood disappeared from the BB inventory would be a bigger problem than verbally taking registration for a patient in transit to a different hospital or trapped in a car. 

[Mabel Adams]

When our air ambulances give blood, it is wrapped into the charges for their service.  I don't believe they charge by line-items.  We bill the flight service for any units used.  I don't know how it would work with a ground ambulance.  We have contracts with the flight services that covers this.

If they use the blood we supply to them to fly a patient from a scene to a different hospital, they tell us who the patient is (Name, DOB at least) and we enter them into our BBIS (SafeTrace Tx) even if they have never been registered in our HIS.  We have a protocol to assign them a fake MRN to keep STTx happy.  This might not work with Meditech because the BB module doesn't have separate patient registration capabilities as I recall.  If the patient has a record in our HIS, we use their established MRN but create a visit in STTx.  We manage final disposition for all of their units.  It is in the contract that any recall will be sent to them for follow-up with recipient. This has never been needed.