transfusion policy's for out of "network" clients

[tkakin]

I am working on creating a policy to create some guidelines for doing testing associated with transfusion to hospitals that are not a regular customer.

 

 

They are remote and use us only when they have to transfuse stat and patient has an antibody.

 

I am asking for you to share some policies on how you would manage a hospital that needs your help

 

I would appreciate any ideas, guidance, and policies you could share. 

 

Thanks Teresa

 

[David Saikin]

I always try to get a specimen and do the abid to provide ag neg/ahgxm compatible rbcs. Sometimes the facility calls and just asks for ag negative blood - I give it to them if I have it/can find it without too much hassle. My blood supply is limited so if they multiples unless they are K and E together I make them get if from the Red Cross.

[mollyredone]

We do antibody ID's for the VA hospital in town.  They only perform screens, so if they have a positive screen, they send us the sample to work up.  They have ARC as a blood supplier, but we don't so if they need units they would order them from ARC.  If we can't finalize the workup, we would forward it to the ARC for completion.  They are billed for whatever workup we do.

[R1R2]

I assume that your lab has some sort of agreement (contract) in place?  I would have an SOP at your facility and a corresponding SOP at the other facility spelling out who does what and when.   I would make sure that the hospital is  up to date with their accreditation too.   

 

We supply blood to a rehab facility.   I review their blood admin policies, transfusion reaction policies and specimen collection policies.  I provided training to the rehab facility on using the blood transport/storage coolers.    I perform blood administration audits at their facility and provide quality data for their quarterly QA meetings.      

[tkakin]

Thanks for your replys. 

Sadly no there is no contract and as far as I can see they have no intention of signing any contracts.  They refuse to share procedures.  From experience of receiving specimens from them we have very different policies/procedures which is causing me migranes.  They also use ARC and we do not. 

So is it best to write them a procedure for sending us specimens for work up and outlining what testing we will or will not perform?  I am nervous to do any crossmatching for them because of the lack of contracts/procedures/trust.  Would we still be responsible for the transfusion if we did the ABID and antigen typing of units/ patient?

[R1R2]

I would talk to your lab manager/Risk department.    

[tkakin]

Thanks R1R2, I did and they asked me to reach out and see if others have had similar challenges.  Maybe someone has already found a  good way to resolve this issue.  From what I have read this is the best place to go   I suppose I am really looking for a way to present this "challange" to the Pathologists' with a solution.  I realize in the end it is their call on what, when and who we do it for. 

 

If there is no contract do you not provide the service? 

Do you provide part of the service such as ABID and antigen typing only?

Do you provide the full workup with crossmatching and products?

Mollyredone do you have a contract with the VA?

David Saikin do you do full workups for them?

 

Thanks

[R1R2]

What do you do for other send out tests?   Somewhere, somehow agreements have been made with these facilities, mostly for billing purposes though.  Maybe look at it from that angle.

[mollyredone]

Yes, we have a contract with them to do antibody workups and a procedure here.  I don't know if they have a procedure in place at the VA.  We just changed blood suppliers, so we don't currently supply blood to them.

[Likewine99]

I agree with R1R2 about getting your risk management department involved.  And you should pull in the legal eagles and the billing people too.

 

And how are they documenting vitals, IV solutions etc?  

 

I set up an offsite transfusion policy a while back and it was a lot of work.  Think about what you would do if a patient suffered an adverse outcome, you have a look back etc.

 

Good luck and keep posting.

[Mabel Adams]

Do you do a blood type on the specimen as well as the ABID?  Even if they don't order it and don't want to pay for it?  If not, I would be pretty uncomfortable doing a crossmatch for them--especially if I could have no control over their processes, training and competency. Are they repeating the crossmatch after you send the units?  Can you send the results with a disclaimer that units are not assured to be compatible in vivo based on only your testing? 

[tkakin]

Hi Mabel,

You bring up some really good points.  They are repeating the crossmatch but I heard from a coworker that had a phone conversation that they do not do the ABO portion of the xm only the gel. yikes. I have had to use a disclaimer on pretty much every test they have asked us to do because of specimen issues.  If they want us to crossmatch we do the full workup. 

[Mabel Adams]

I assume they don't have a blood bank computer system with an algorithm that confirms the ABO compatibility either?  AABB is pretty clear that is an acceptable form of checking ABO compatibility when doing a gel crossmatch now.  Have to do IS with the gel when the computer goes down of course.  

 

As long as they are repeating the crossmatch and taking final responsibility for it you are probably OK.  Are these warm autos or antibodies to gel diluent that you are even doing a xm for them?