Multiple Hospital Systems

[Marianne]

We are part of a multiple hospital system where many services lines are consolidated at certain sites and patients move between hospitals.  The labs have some limited shared testing, but are each independent with their own CLIA and Lab Directors.  Each hospital assigns a unique MR# and FIN.  We are starting to see more and more instances of a patient being typed and screened at one site and then transferred to another site within the system for surgery or renal patients moving back and forth within days.

Just wondering how other systems similarly set up are managing the patient samples and test results.  Currently we are redrawing and retesting.  If anyone is "sharing" Transfusion samples or is managing this in another way that meets all the regs, I would welcome some ideas!

Thanks-

[R1R2]

With unique FINs and MRNs at each hospital it would be hard to manage this.   This would be possible if you had a unique lab ID that stayed the same through all the encounters IMO. 

[kirkaw]

We are a 4-hospital system with the same HIS but 3 of the 4 hospitals have different MRN's and all hospitals issue their own encounter # for each visit.

We do have a unique blood bank identifier # that prints on the patient's armband that is the same across facilities and across visits.

However, each time a patient is transferred to a different facility, we require that the receiving facility get a new type and screen specimen. The only time this is not true is for preadmit/pre-surgical patients. If a patient wants to have their blood drawn at a sister hospital because it's closer to their home, they can do so, but the specimen is collected and labeled with a handwritten label and the order is a paper requisition. Both of these items are delivered to the facility where the patient will have their surgery, a new encounter is registered, the type and screen ordered and the testing performed. The specimen remains at the testing facility where the patient is having surgery.

[Mabel Adams]

We tried to think of a way to let patients move between hospitals (besides pre-admits) but concluded that the most important ones would be emergencies moved to the larger hospital and we would never get the timing right to move the specimen to the receiving hospital when the patient moved.  With electronic crossmatch, you can kind of get around this, but if they have a reaction, we would need the pre- specimen to compare to at the transfusing hospital.  We ended up using different colored blood bank bands at each site and taught nurses to transfuse only with their own colored band (or a clear colored band for OP draws like pre-ops and OP transfusions) so now we can't really go back.  Also, ED is in the habit of cutting off all bands when the patient arrives from elsewhere and we doubted that we could get them to leave blood bands alone.  We redraw and start over.

[bpkelly]

Policies need to be set at system level for Patient identification and specimen labeling. Our system allows preop draws at one of our facilities for surgery/transfusion at another system facility. Registration is the biggest impediment and results in a lot of testing being done "on paper" and then entered into the correct admission once the patient is registered. If anything in the patient registration is a mis- match, Type and screen is redrawn.