Our Hospital recently purchased another local Hospital. The other Hospital was owned by a large Medical Association. They left, taking anything/everything they wanted from the Hospital, and left us the leftovers. The previously owned Hospital has been closed for a few months, and will be reopening next month, as kind of a "sister" Hospital.

As Blood Bankers, we know how valuable (and necessary) it is to have a history on patients, especially those with Antibodies (in fact, is required within a given Institution). However, the previous owners of our "new" Hospital, will not give us their Blood Bank Data; either to download, or even the hard copy cards of Antibody Patients (which they have on file). They have only agreed that if we call them on a particular patient, they will fax us the information. I would then forsee us calling on "every" patient. I cannot think of a reason why they would do this. Does anyone know if it is some kind of liability for them to give us the Blood Bank histories on their patients?

Thanks,

Brenda Huston, CLS(ASCP)SBB

Sounds like something you might want to consult your hospital attorneys about??? I certainly understand your point, but do the previous owners "own / have custody of" all the patient records from the hospital that has just changed hands? If so, I could see how the "powers-that-be" would consider the patients' Blood Bank records to be in the same category as the rest of the patients' medical records.

Hmmm.....I wonder what would happen if your staff did indeed call the "large Medical Association" on every patient who does not have a BB record at your current institution....?

Hi Brenda, I have absolute sympathy with your plight in this case. I have never heard such utter nonsense in all my life.

Under the circumstances, you are correct in saying that you will have to contact them for each and every former patient of theirs.

Have the people in charge of the former hospital never heard of an anamnestic response to an atypical alloantibody that is no longer serologically detectable, but which is quite capable of causing a clinically significant delayed haemolytic transfusion reaction? I refer to anti-Jka as an example, and to the various annual SHOT reports in the UK for evidence.

I do not usually approve of the "compensation culture" presently in vogue around the world, but, If I had an anti-Jka, which they knew about and which was no longer serologically detectable, and I sufferred a clinically significant delayed haemolytic transfusion reaction due to their ignorance, I would sue them for every pound (dollar) I could wring out of them.

In the UK we are planning to work towards a computer programme that contains all the patients with known alloantibodies and/or rare phenotypes, so that the data is available to all Hospital Blood Banks. Admittedly, this will take some time, as it will be expensive (very), difficult to put together to ensure that the data is correct (very difficult) and to make it secure, from the point of view of governance, so that the information is only available to those that really require it, but this is the way the ex-owners of the hospital about which you write should be going; not towards ever more secrecy.

:mad::mad::mad:

Hi Brenda,

Would the FDA be interested in this via the CFRs or are there any regs over lookback and traceback procedures?

Well again, I know the regulatory agencies care about this for any "given Hospital;" but there may be underlying issues/reasons that another Hospital would not/could not, just hand over all of their patient information to another facility.

I wish I "did" know if there was a regulation that either requires that they hand over the data, or, that explains to me/us, why they cannot do that.

As Blood Bankers, we all know that our "gut" says "hand over the data on your antibody patients and no one will get hurt;" but again, there may be laws and/or regulations around this that I simply do not know. I mean when you think about it, we all have patients coming in every day who have been transfused somewhere else, but we are unaware (and if we obtain a negative antibody screen and the patient has an anamnestic response, we cannot later sue another hosptial for not telling us about it).

I like the idea of there being a National Registry of Antibody patients.....for their sake.

Anyone out there know from a regulatory standpoint if this is addressed?

Thanks,

Brenda Hutson, CLS(ASCP)SBB

Well again, I know the regulatory agencies care about this for any "given Hospital;" but there may be underlying issues/reasons that another Hospital would not/could not, just hand over all of their patient information to another facility.

I wish I "did" know if there was a regulation that either requires that they hand over the data, or, that explains to me/us, why they cannot do that.

As Blood Bankers, we all know that our "gut" says "hand over the data on your antibody patients and no one will get hurt;" but again, there may be laws and/or regulations around this that I simply do not know. I mean when you think about it, we all have patients coming in every day who have been transfused somewhere else, but we are unaware (and if we obtain a negative antibody screen and the patient has an anamnestic response, we cannot later sue another hosptial for not telling us about it).

I like the idea of there being a National Registry of Antibody patients.....for their sake.

Anyone out there know from a regulatory standpoint if this is addressed?

Thanks,

Brenda Hutson, CLS(ASCP)SBB

I agree with you Brenda (underlined bit), but this is, essentially, the same hospital, isn't it!?!?

Well, yes and no; it is the same "Facility," but it will have our name (plus location) and be run very differently than the previous owners. I think the difference has to do with the fact that the other Institution actually "closed its doors," and when the "facility" re-opens, they will be a different Hospital.

Brenda Hutson, CLS(ASCP)SBB

Fair comment; but surely they must still have some responsibility. After all, if one of their patients' operations went wrong (say they left a swab in the abdomen) then the patient would sue them, not your establishment. If they cause a transfusion reaction due to their "secrecy", then the same would apply??????????????????

In most states in the US, a corporation must have permission from the state Health Department to close a hospital. As part of that, the custodian of all the medical records is named--in this case, who is named as custodian of those records?

Also, do you expect the patients at this new facility to be the same patients who were there under the old corporation?

Maybe if you call them on every patient, they will eventially get tired of looking up each record and give you copies.

I think it is something called HIPPA

HIPPA has nothing to do with this . . .

The question is "Did you purchase the hospital or the building". When we purchased/merged with other hospitals we shared data by bringing them into our LIS. But if you purchased a building that used to be hospital and is going to be a hospital again, I don't think the records would belong to you. They belong to whoever had previous hospital. These sound like 2 completely separate entities.

I worked in a city that had 2 hospitals. When hospital number one closed, they did not give us BB history on all of their patients that would now becoming to us. I don't see this as any different.

I am not writing this to be smart, but as laboratorians we must know that the acronym is HIPAA (not HIPPA) for Health Insurance Portability and Accountability Act.

When we opened our Transfusion Service last year (8-2008) we ran into a similar difficulty. Most of our patients had been transfused at the hospital across the street from us. I started by looking at the list of transfusions our nurses had done here and gathering patient names. I emailed a request for records for this group of patients and was told I couldn't have them.

What I ended up doing was making a Request for Records that we fax to the hospital blood bank everytime we get a patient. I had to make it specific though or we would get just a blood type and nothing else.(see attached) We also put the time and date of the request because they get busy and we are not a priority for them. We then enter the results of this history in our computer system under comments.

What I find interesting is that they seldom ask us for histories when the patient is admitted there. I do make it a practice to fax new antibodies or special needs on patients that I know they have a history on.

Record Request.doc

Did the "new" Medical Record department acquire the previous patient charts? Or were they restricted too? I would imagine patient records maintained within a department would be legally treated the same as records in the MR dept.

Edited June 24, 200916 yr by PammyDQ
wording :)

When we opened our Transfusion Service last year (8-2008) we ran into a similar difficulty. Most of our patients had been transfused at the hospital across the street from us. I started by looking at the list of transfusions our nurses had done here and gathering patient names. I emailed a request for records for this group of patients and was told I couldn't have them.

What I ended up doing was making a Request for Records that we fax to the hospital blood bank everytime we get a patient. I had to make it specific though or we would get just a blood type and nothing else.(see attached) We also put the time and date of the request because they get busy and we are not a priority for them. We then enter the results of this history in our computer system under comments.

What I find interesting is that they seldom ask us for histories when the patient is admitted there. I do make it a practice to fax new antibodies or special needs on patients that I know they have a history on.

That sounds a great idea, BUT, we have been told (in the NHSBT) that we must get confirmation of the receipt of the faxes we send, because faxing is so leaky, and, of course, we, like you, are faxing patients' private details. Do you have to do the same and, if not, do you think that you should?

I must admit, it is a pain!!!!!!!!!!!!!!!!

I'm curious. On every new patient that comes into your facility do you ask them if they have ever been in an other hospital and if so do you contact that hospital to see what history they have on this new patient?

Personally I think you are trying to make the Alps out of a grain of sand.

Actually, I do talk to all the new patients. Our setting is small and we pride ourselves on exceptional patient care and personalized service. I have called New York, California, Wyoming and other places to get a history. Having seen a fatality from a delayed transfusion reaction (Jka) makes one very cautious (18 years ago). If I can take 2 minutes to ask the patient if they have been transfused before and if so when and where and possibly save a life I will do it every time. I have that luxury here.

It may or may not interest you to know that I am a BSMT first and an RN second (went to nursing school because I wanted a challenge; it wasn't but I learned patient care).

Also, Malcolm...our fax is secure and the other facility also has a secure fax.

Thanks for that Trektech2. I only wish I could say the same about ours!

Trektech2

I am glad to hear your practice is small and you can take such a personal interest in each and every patient you contact. You are to be commended for that practice but in the world I lived in for 25+ years that simply was not feasible. Life is uncertain and everyday is a gamble. There is only so much that can be done to address real and/or imagined threats. At some point a line must be drawn or you will stress yourself into an early grave.

I do agree with you that life is a gamble John (and, much more rarely, a gambol!), but, getting back to the origin of the thread, if the information is there, it should be made available.

A comment about HIPAA: this is not a HIPAA issue. HIPAA is used as an excuse way too often. Obtaining a clinical history on a patient for their treatment (patient safety) is within the guidelines for "needing to know" the information. We often call other hospitals when we need to obtain an antibody history, and occasionally I am dismayed that they use HIPAA as a reason for denying the info.

We have the same problem over this side of the Atlantic with the Data Protection Act, even when we are only asking if the patient has received anti-D immunoglobulin prophyaxis, when they have a low level of anti-D.

In such situations, do we issue an antibody card for the patient (which may mean that they miss out on anti-D immunoglobulin prophylaxis later) and treat it as immune, or do we not issue such a card? We usually do not issue such a card under these circumstances, but honestly, how short-sighted to hide behind such a law.

Often when faced with an ambiguous antibody identification workup, we may inquire whether a patient has received treatment at another facility. (Usually it's better to ask this rather than ask if the patient has received a transfusion because occasionally patients don't answer accurately.) We may get this information or clues from the electronic medical record which we in BB have access to, or by asking the nurse to ask the patient, and occasinally calling an outpatient at their home.

In the past week alone we have 1) called a Maryland hospital & found a patient whom we found only 2 weak positive reactions on panel with no obvious specificity had a history of Anti e, c, Jka; 2) Called a patient with a "strange looking" warm auto (eluate & plasma workup positive & the XMs were negative) to learn that she has lifetime history of autoimmune disease with no transfusions or pregnancies, therefore little chance of underlying alloantibody.

We also frequently call local BBs for info and never have a problem sharing. Of course, NONE of this is required by our policies and procedures, but as Blood Bankers with good patient care in mind we go the extra mile when we feel it necessary!

Of course if a negative transfusion outcome occurred due to an anemnestic response, we would have no personal liability of not having dug deeper when our gut told us to. But I imagine by avoiding this possibilty, we may could be saving our employer some legal headaches without them ever knowing our contribution as laboratorians. We just care about our patients!

Pammy DQ, I admire your ethos. Of course as Blood Bankers we should go the extra mile, and this is why I sodespise the attitude of the closing hospital mentioned in the initial post.