Hi all-

I'm trying to find the specific standard regarding sharing of pre-transfusion testing results between hospitals. We all know that if patient receives blood at hopsital "A" and then is transferred to hospital "B" across town, that the Type & Screen and 2nd determination of blood type needs to repeated at hospital "B" before units can be allocated. So, can someone provide the specific CAP and/or AABB standard(s) that would prevent hospital B from using the results from hospital A?

In case you're wondering! We're in a situation where the blood bank at our hospital has been doing pre-transfusion testing and supply of blood products to a stand-alone ED located about 10 miles away. This ED was always considered an "extension" or "area" of our hospital, and if the patient was drawn there, but then transferred to us for a higher level of care, it was seamless because the patient - and specimen - were considered "ours". However, starting last month, the ED site has now expanded to include surgical suites and been designated as a separate hospital. We still do all their testing because they do not have their own blood bank, but when we result the type and screen, we do it under their hospital ID in the LIS (Sunquest). The problem is that if one of their patient is now transfered to our facility for a higher level of care, we are having to rearmband, redraw, and retest the patient - just as if they had come from any other hospital.

I don't think there's a workaround as long as the new hospital is treated as such in Sunquest, but I need to give the administrators a good reason why the patients are having to be restested. Any thoughts/guidance are much appreciated!

50 minutes ago, kjmiller said:

We still do all their testing because they do not have their own blood bank, but when we result the type and screen, we do it under their hospital ID in the LIS (Sunquest). The problem is that if one of their patient is now transfered to our facility for a higher level of care, we are having to rearmband, redraw, and retest the patient - just as if they had come from any other hospital.

I think this is the key: Is initial testing at that ED is under one patient identifier/armband and the testing at your facility under a completely different patient identifier/armband?

It's less about the testing, more about the patient identification.

From CAP:

TRM.40230	Specimen Labeling for Pretransfusion Testing	Phase II
	All blood samples used for pretransfusion testing are labeled at the time of specimen collection in the presence of the patient with: 1.       Patient's first and last name 2.       Unique identification number 3.       Date of collection 4.       A method to identify the individual collecting the specimen. NOTE: Blood specimens collected for pretransfusion testing must be positively and completely identified and labeled before leaving the patient. Acceptable practices for positive identification of patient and blood specimen labels must be defined in the procedure manual and may include visual inspection and/or an electronic system to read the identifying information contained in bar codes or radio-frequency identification (RFID) microchips or the patient's wristband. Acceptable practices for generating specimen labels must be defined in the procedure manual (refer to GEN.40490) and may include electronic devices utilizing information encoded in bar codes or RFID microchips. There must be a dependable method to identify the individual who collected the blood specimen, such as initials or another identifier on the tube, or an electronic record. Evidence of Compliance ✓        Properly labeled blood specimens AND ✓        Records identifying the individual collecting pretransfusion testing specimens

Thank you, Kelly, for your reply. As it turns out, patients admitted to their new facility have unique MRNs, but patients seen at other hospitals within our system have a shared MRN. The fact that only the new facility is assigning different MRNs does complicate matters when conducting patient history searches, but I don't think that's the only reason we can't use their specimens. For example, when we admit a patient from one of our other sister hospitals - with whom we have common MRNs - we still draw and test our own specimen, and wouldn't administer blood products based on the testing done in their blood bank.

I don't think there is a requirement to share between hospitals, only that a search of previous records was performed for ABO/Rh and antibody screen. The lab needs to define how they will perform the search. The reasoning that labs use 2 types is a. to limit mistransfusion events and b. to use electronic crossmatch. You don't need 2 types is you aren't using electronic crossmatch and if you use other ways to reduce mistransfusion risks- you can always use immediate spin to allocate type specific blood. To use a type from another hospital, personally, I would want the testing/results to show up in my LIS automatically, and know that my lab and the other lab follow the same policies for patient ID, labeling, testing, etc.

TRM.40300 Historical Record Check

TRM.40670 ABO Group and Rh(D) Type Verification

TRM.30550 Misidentification and Mistransfusion Risk Monitoring

TRM.30575 Mistransfusion Risk Reduction

(Slightly paraphrased from the Guidance to the 34th Edition of AABB Standards for Blood Banks and Transfusion Services) AABB Standard 5.14.8 requires that there be 2 determinations of a recipients ABO group..... the first determination must be on a current sample and the second determination may be determined by one of the following methods:

1) comparison with previous records

2) testing a second sample collected at a time different from the first sample

3) retesting the same sample if the patient identification was verified at the time of sample collection using an electronic identification system.

CAP standards (12/2024) Changes to Standards clarifies the requirement even further:

"In the transfusion medicine checklist, TRM.40300 Historical Record Check says ABO, Rh, and antibody screen test results must be compared with results of the same tests recorded previously to detect discrepancies and identify patients requiring specially selected units. “New language was added to this existing requirement to clarify what is acceptable ABO and Rh historical records,” says Matthew Karafin, MD, MS, chair of the CAP Transfusion, Apheresis, and Cellular Therapy Committee and clinical professor of transfusion medicine services at the University of North Carolina at Chapel Hill. The revised requirement now says the acceptable ABO and Rh historical records for transfusion purposes are only those generated or entered by laboratory personnel into the health system’s laboratory information system and performed by an accredited lab or certified by the relevant government agency in its jurisdiction.

“We learned that assessors have encountered facilities that were using blood types from other institutions, such as from Epic Care Everywhere,” Dr. Karafin says. “Moreover, we were made aware that blood typing information from these other institutions was sometimes being added by non-blood bank personnel, so we had concerns about the reliability of this information.” For patient safety, the CAP wants to ensure that the ABO and Rh used for transfusion are the ones that laboratory personnel have entered into an LIS. This “implies that a transfusion service reviewed the information and was responsible for its data entry,” Dr. Karafin says."

2 hours ago, kjmiller said:

For example, when we admit a patient from one of our other sister hospitals - with whom we have common MRNs - we still draw and test our own specimen, and wouldn't administer blood products based on the testing done in their blood bank.

Your policy (to draw and test your own specimen) is the strictest interpretation of the standards (and one that most blood banks likely follow), but I do believe you'll find systems that share MRNs, share LIS, share policy & procedure (may even share technical staff) that will use pretransfusion results performed in blood bank A to transfuse the patient at location B by technical staff in blood bank B and are doing so within AABB and CAP standards.

All that is to say, I don't think you'll find a standard that explicitly says you have to draw and test your own specimen at your own physical location. We come to that conclusion because of all the other standards.

In our facilities, it also has to do with the Cost Center.

Even if they transfer with the same MRN/FIN, our "Mother" hospital cuts off the band and repeats testing.

Thank you everyone for your very helpful replies! We are definitely no longer a shared cost center, and I appreciate those who shared knowledge of the specific relevant standards. This is just what I needed. Thanks again!

As a facility that uses Care Everywhere for previous blood bank history (ABO/Rh type and clinically significant alloantibodies), it is a very useful tool but must be reviewed carefully. As the CAP brought up, Epic does allow a "historical provider" to manually enter blood types - and we have seen many examples - so made it part of our policy to not use that information as an example of a historical blood type - we must see where the result was reported by a clinical laboratory. With the December 2024 Changes, we may be moving toward historical information within our LIS only (we are currently a 13 hospital system that shares SoftBank) as we standardize policies and procedures across all facilities.

We previously used Sunquest - and would use information shared within Hospital ID (HID) -as part of our history check. Don't know if that is a viable option.