electronic xm'ing within a hospital system, does it matter where the specimen is?

[suhu]

We have several full-service blood banks at hospitals within our system. We share the same computer and patient identification systems.

Here is a scenario:

Specimen drawn at a system clinic and sent to hospital A.

Specimen is processed at hospital A and patient qualifies for electronic crossmatch.

Patient is admitted to hospital B and blood transfusion is ordered (within the 3 day time-frame)

Is it acceptable for hospital B's blood bank to access the patient record, perform an electronic crossmatch and issue blood to the patient? In other words, can a specimen be processed at one facility but the units electronically crossmatched and issued at a different hospital (within the hospital system)?

[csjuarez]

I would not be comfortable with that arrangement -- I would want my hospital to do the testing on which the transfusion will be based. In addition, there may be patient identification issues, and you should have a pretransfusion specimen available in case it is necessary to follow-up a transfusion reaction or other issue related to the transfusion.

[adiescast]

Does the patient retain their ID (armband or whatever form your system uses) when they are transferred between hospitals? It seems to me that if the patient is wearing an armband that is the same as the one used to ID them at collection and you have all of the required computer stops in place, it should be acceptable to perform the electronic crossmatch anywhere in your system. I believe that there are locations that are doing electronic crossmatch on issue that don't have the sample present at the issue location.

[adiescast]

I would not be comfortable with that arrangement -- I would want my hospital to do the testing on which the transfusion will be based. In addition, there may be patient identification issues, and you should have a pretransfusion specimen available in case it is necessary to follow-up a transfusion reaction or other issue related to the transfusion.

If a system is already accepting results from one hospital to another by using the same computer system, how is this different? If the patient has a problem, the original sample would have to be obtained for the reaction workup.

[Marilyn Plett]

Some computer systems can be configured for "remote" crossmatch and issue which would seem applicable to your situation. SafeTrace Tx comes to mind. If I remember correctly, segment numbers play a role in that process. The system has to be validated for your circumstances. Do all of the hospitals in your system use the same SOPs and have the same training? I think you could have a process, but you all need to agree on it and create an SOP.

[velliott]

Of course I'm from the old school.....I also would have an issue, but "the times they are a changing." I think you would need a detailed SOP to retrieve the specimen if it were needed for a workup. I assume at this point, everyone is using the same sample storage and SOP?

[clmergen]

We are considering this for the future, when we upgrade from Cerner Classic. With smaller hospitals using generalists covering more than one department at a time, we think this may actually be safer.

[Steven Jeff]

Can I ask whether the sample is being tested on a fully automated blood transfusion analyser with the results being downloaded to the computer system without any human interpretation?

Regards

Steve

:)

[clmergen]

I didn't realise this thread started last year. But yes, we are automated with download results without human interpretation whenever possible. If the instrument can not interp, then we tube test.

We are just in the consideration phase but Transfusion seems to be problematic at the smaller sites, specifically getting well-trained personnel on the evening and night shifts. At the main hospital, we have techs around the clock dedicated to just Transfusion Services so we think we may benefit from this.

[Steven Jeff]

Like you I hadn't realised this was an old thread being revitalised.

I would suggest that provided the grouping, antibody screening and download to the computer system is fully automatic with no human overide or edit then the results would be acceptable to other hospitals within the same group to allow electronic crossmatch.

Steve

:)

[Malcolm Needs ☆]

I agree with Steve.

In fact, some places have been doing remote electronic issue in other hospitals for years; certainly there is one city in the USA (I can't remember which off the top of my head - anyone know?) and it has also been done in Australia.

For some reason, Chicago comes to mind; which, with my memory, probably means it was somewhere in Alaska!

:):)

Edited March 12, 2010 by Malcolm Needs

[rravkin@aol.com]

Suhu,

I work in a similar system as you and we practice that the BB of the hospital where the patient resides has to have a current specimen there in order to issue blood products.

[Steven Jeff]

We are exploring the provision of a Blood Transfusion service to 6 other Hospital sites (less than 80 beds) all within a radius of 35 - 40 miles of each other, from a hub laboratory. None of these hospitals has an A&E or Trauma unit. Electronic remote release of blood from satellite blood banks will be facilitated using Blood Audit and Release Software (BARS). All samples for blood group and antibody screen will be processed at the hub laboratory on automated Diamed Gel stations. When blood is required at a satellite hospital it will be released remotely by the laboratory staff at the hub laboratory. There will be no requirement for blood bank technical staff at any of the remote sites, which is great if you are located at the hub laboratory

Regards

Steve

[Bill]

According to Part 58.2 of New York State Lab Regulations, this would only be possible if the transfusing hospital was a limited transfusion facility. That is, they do no testing and receive all their blood, xmatched or un-xmatched from the testing transfusion facility. Otherwise, only the testing transfusion service can issue the unit of blood for transfusion. But then NYS Lab Evaluation Unit is not known for being very forward thinking.

[adiescast]

I agree with Steve.

In fact, some places have been doing remote electronic issue in other hospitals for years; certainly there is one city in the USA (I can't remember which off the top of my head - anyone know?) and it has also been done in Australia.

For some reason, Chicago comes to mind; which, with my memory, probably means it was somewhere in Alaska!

:):)

It is possible that there are several places doing this, but I observed it in Seattle, WA. They had transfusion centralized to their donor center and printed tags at remote locations. There are other centralized transfusion services in the U.S. that may be doing similar things (although I do not have confirmation).

[Malcolm Needs ☆]

It is possible that there are several places doing this, but I observed it in Seattle, WA. They had transfusion centralized to their donor center and printed tags at remote locations. There are other centralized transfusion services in the U.S. that may be doing similar things (although I do not have confirmation).

YES, that was it; Seattle.

I knew my memory was going!

:eek::D:eek:

[vilma_mt]

it seems like it should be new specimen for each/every admission whether it's same hospital or different hospitals within a system. Blood Banks usually re-draw a specimen if patient went home and came back and re-admitted within 3 days. This scenario is totally different from hospital B performing compatibility testing for a transfusion in hospital A who has limited transfusion service testing. I guess as long as your validated system allows it, it can be done if SOP is created, contract drawn signed by your Pathologists and Administrators from each hospital.

Edited March 17, 2010 by vilma_mt