Are there any Critical Access Hospitals using a Blood Bank System

[cassiepenn]

Hello,

 

I am curious to see how many Critical Access Hospitals have a Blood Bank System.  If you have a system what are you using and how did you get administration to approve the system?

 

Thanks,

Cassie

[tricore]

What is a critical access hospital? We have a level one trauma center and a tertiary care hospital that have had blood bank systems since the mid eighties. The labs were computerized before the blood banks. Not many BB systems around then. From a patient safety perspective: If you have a blood bank system and it is set up correctly it will not let you issue anything other than a group O for an untyped patient or group incompatible if the patient has been ABO typed. All of a patient's records are together, historic antibodies, special requirements,typing problems, etc. The computer files alphabetically better than a person. I used find cards filed in the wrong file drawer.

It will not let you issue a non-irradiated unit to someone who needs it to prevent GVHD. It will not let you issue an RBC that has not been antigen typed or is positive for the antigen to which a patient has an antibody. Of course if you allow it these warnings can be overridden or the tech can not use the system! One lawsuit = one computer system. Caveat: Garbage in, garbage out.

[cbaldwin]

A Critical Access Hospital (CAH) is a hospital certified under a set of Medicare Conditions of Participation (CoP), which are structured differently than the acute care hospital CoP. Some of the requirements for CAH certification include having no more than 25 inpatient beds; maintaining an annual average length of stay of no more than 96 hours for acute inpatient care; offering 24-hour, 7-day-a-week emergency care; and being located in a rural area, at least 35 miles drive away from any other hospital or CAH (fewer in some circumstances). The limited size and short stay length allowed to CAHs encourage a focus on providing care for common conditions and outpatient care, while referring other conditions to larger hospitals. Certification allows CAHs to receive cost-based reimbursement from Medicare, instead of standard fixed reimbursement rates. This reimbursement has been shown to enhance the financial performance of small rural hospitals that were losing money prior to CAH conversion and thus reduce hospital closures.

[cbaldwin]

I work in a critical access hospital.  When our hospital purchased a new information system--Paragon--in 2012, a blood bank system--Horizon--was included.  I think the BB system cost $30,000.

 

We have not yet used the Horizon system because our IT department is busy fixing problems they find with Paragon and keeping up with updates.  Although we have a small workload I would like to use the system.  I see a lot of typos and data entry errors (data entry errors into the LIS) in our transfusion service.  My understanding is that the Horizon system would alert us to some of these errors.

 

In 2012 we had no problem convincing the administration that a BB system would improve our TS by cutting down on errors. 

[AMcCord]

I do agree that a blood bank system would be cheaper than a lawsuit, but when the overall needs of the facility are weighed against the cost of something that isn't going to be used a great deal, hospital management isn't as likely to pick the blood bank system unless they are swimming in money or they can get a good package deal with a house wide upgrade. In my state most critical access hospitals are independents, often community or county owned and are not swimming in money.  

Edited August 29, 2014 by AMcCord

[Likewine99]

There are probably some CAHs out there using a BB system but I bet they are few and far between.  

 

AMcCord is correct, a BB system may be cheaper than a law suit.  As a BBer and IT person I can tell you it is very expensive upfront and upgrades, maintenance and system validation are very time and labor intensive.

 

If you have Horizon BB it would need to be thoroughly validated, a validation plan written and approved, lots of documentation generated during the process.  I applaud you for wanting to use the system, you'd have to weigh the return on investment to decide if you really want to implement the system.

 

Good luck!

[Mabel Adams]

Horizon BB (recently renamed McKesson BB) is just rebranding of the Haemonetics system Safe-Trace Tx (used to be Wyndgate).  We use it as do 2 critical access hospitals that are a part of our system.  Another tiny hospital (I assume it is a CAH) that is not a part of our system contracted with us this year for IT services and went on our EMR, LIS and BBIS.  That is how they could afford these systems.  BBIS validation was a part of the contract.

 

BB systems are rather complex and it is a challenge for users to deal with some of these issues when they come up very rarely.  No human is very good at remembering exceptions which occur every 6 months and are pretty inscrutable until you have seen them several times.  We use a model where we just have them call our main hospital's BB superusers (on duty pretty much 24/7) with problems and we talk them through them until it starts to make sense to the infrequent users.  The main BB sees these issues pretty frequently.  It is also not good to stumble through problems in a BBIS because sometimes the problems get very hard to fix when you consider legal orders, visit numbers, results, billing, final disposition of units, patient ID and history etc.  This is the other reason we beg them to call first rather than try to fix it themselves.  Maybe other systems are easier than ours but this issue is worth considering when deciding to install a system.  It also depends somewhat on whether you have some really computer-savvy people who want to become the BBIS experts.  Regular IT folks often overlook details and can cause havoc with a BBIS so a watchdog is needed.