Hi. We are a small community hospital in western PA. I am currently trying to get approval to get the Immucor Echo. We have OB, oncology, inpatient, and surgical services. We are nearly pulling our hair out trying to keep up in the blood bank. I have presented all of the cost analysis, tech time savings and return on investment to administration, but still no luck. It is going to cost about $5000 more per year for the automation and they are not sold on that yet. They have now asked me if there is a national benchmark for ratio of tech: tests performed for blood bank. I can't find anything. Our data is based on an average of 14 type and screens per day, but of course that doesn't include the antibody workups, irradiation of blood products, QC, inventory, receipt of products from the blood center,temperatures, and all of the other things that go into a blood bankers day. Do any of you have any information that would be useful to me to help administration understand our need? Or any other suggestions on what to try? They have worn me down, which I think is thier point!

Here is part of my justification for teh interface for an instrument. I thought it might help. Focus on the the dangers for errors.

My hospital does not have a dedicated Transfusion Services staff. Routinely, the technologist working in Transfusion Services may be covering other areas of the Laboratory. Manually entering Type and Screen results into LIS gives the technologist eleven opportunities for error. An incorrectly entered blood type can be a fatal error.

If you have evidence of "near miss" events from your lab or others, because they were manual testing/ entering results that may help. If you look through the UK SHOT reports in the library section of this site - you could quote any cases of incorrect blood being transfused, that would have been prevented by having automation.

As clmergen mentioned, focus on the dangers, write a risk assessment around these issues and then present this. Ultimately if things go wrong litigation against the hospital will be much more than the $5K difference.

Something else to look at is overtime and staff turn over. $5000 / year is just under $500 / month. It dosen't take much overtime to eat up that $500. When we became automated our over time disappeared. Also, the stress the staff was under essentially vanished as well. A happy staff is one that will be with you a long time.

The other thing I focused on was that once we were automated any work load increases could easily be absorbed with little impact, if any, on the staff. For us it had become an issue of either automation of increase staffing. They chose automation and we never looked back.

Good luck.

You mention tech time savings--what will the tech do during that time? If you have additional tests identified, put the new revenue for these tests in your cost analysis; I bet you can make up that $5,000 easily.

Can you tie it to patient safety? Less chance of an error with an automated analyzer. Facilitates crosstraining of techs which benefits the lab overall.

Don't forget if you automate you can eliminate some QC at the bench if you are using like methodology and reagents, this saved us about 45 minutes/day plus reagents.

I agree with all of the above.

I would really hammer the increase in safety (and the possibility of litigation if they don't provide the money for the change). Break the safety things down into as many bullet points as you possibly can, such as positive sample identification.

Play them at their own game, and wear them down.

Good luck.

Thank you to all who have given advice. Yesterday I made a little spreadsheet entitled "A Day in the Life of a Blood Banker" which broke down all that we do into minutes. I am at 890 minutes of work (there are only 1440 in a 24 hour period) and I haven't even accounted for an antibody workup yet! I have emphasized patient safety which I really thought would push it over the edge... We're not giving up yet, though, so continue to wish me luck! I am meeting with my director today to come up with more ammo...

We too are looking to automation; it seems like non-blood bankers can't comprehend automation or the need for automation in BB. How about sharing your spreadsheet and any additional "ammo" you get?

(I'm in Johnstown, PA...hi! neighbor!)

Hi neighbor! I will try to add my spreadsheet here... if it doesn't appear, give me your email and I will send it to you.

A Day in the Life of a Blood Banker.xls

When you do request the instrument don't forget the interface as part of the package. It can be overlooked but sometimes has to be ordered separately depending on LIS and Instrument.

I know for Immucor reagent pricing is a LOT less expensive for automation than for tube testing. I think Ortho may be the same. Make sure you are using the correct pricing in your justiification.

Also, if you have other cost centers that will potentially benefit from the switch to automation, you need to include those potential savings: how many less tubes will you need to buy? how much less waste biohazardous/sharps waste removal will be necessary?

One process I am looking at is using the IgG crossmatch assay to "pre-screen" units for phenotyping. If you are only phenotyping compatible units, the likelihood of using expensive antisera only to discover that the unit is antigen positive, should net savings in both reagents, tech time, and TAT for finding units for patients with antibodies.

Lastly, instead of using the anticipated "saved" FTE's to allow for attrition or other staff reduction, I proposed using the available tech time to bring back in-house eluates and absorptions....this will save thousands of dollars off of my reference testing cost center. The best part????? They really went for this one as I currently have a large budget line for that cost center..........Hope this helps,

Linda

Thank you to all who have given advice. Yesterday I made a little spreadsheet entitled "A Day in the Life of a Blood Banker" which broke down all that we do into minutes. I am at 890 minutes of work (there are only 1440 in a 24 hour period) and I haven't even accounted for an antibody workup yet! I have emphasized patient safety which I really thought would push it over the edge... We're not giving up yet, though, so continue to wish me luck! I am meeting with my director today to come up with more ammo...

You will let us know the eventual outcome won't you?

I am incredibly curious as to how it will pan out (well, incredibly nosy really!!!!!).

:confused::confused:

I sure will! Even if you're just being nosy!!!

We are also looking for best practice out there...how many patients should a tech be working on at one time using manual gel to ensure patient safety? Some of my techs have come to myself and our director (and these are the cream of the crop techs) and told us they feel they are working at unsafe levels at some times. I know myself, I have had 6-9 patients in my rack at one time. (not to mention the phone and the tube system and handing out units and irradiating blood and... we only have 1 tech each day...) What do you all think?

I sure will! Even if you're just being nosy!!!

We are also looking for best practice out there...how many patients should a tech be working on at one time using manual gel to ensure patient safety? Some of my techs have come to myself and our director (and these are the cream of the crop techs) and told us they feel they are working at unsafe levels at some times. I know myself, I have had 6-9 patients in my rack at one time. (not to mention the phone and the tube system and handing out units and irradiating blood and... we only have 1 tech each day...) What do you all think?

Thanks.

As for the second bit of your post, there used to be a managerial formula (I think it was invented in Wales, but I'm not sure) that people used to find out how hard a person was working (it wasn't a particular popular formula), but it did have an upper limit, beyond which you were working too hard. I can't remember it myself, but this post might serve to jog the memory of someone else who is not suffering from loss of memory due to extreme old age (thanks Rashmi), who may remember or know where to look for this formula, or something like it.

I think you just made one of your best justifications for automation.

JCHO or what ever they call themselves these days would really like to push for blood bankers working on no more than one patient at a time!!! I wonder what the color of the sky is on their planet!

:abduction

I think you just made one of your best justifications for automation.

JCHO or what ever they call themselves these days would really like to push for blood bankers working on no more than one patient at a time!!! I wonder what the color of the sky is on their planet!

:abduction

Thank you!

Is there a written standard from JCAHO stating something to this effect? We are not accredited by them so I do not have their standards and they are not available on their website.

The Sentinel Event Alert is available on the JC website:

http://www.jointcommission.org/SentinelEvents/SentinelEventAlert/sea_10.htm

Of course, push the issue of increased safety. (Think of as many examples as you can, and zero in on the couple couple.)

Is your institution planning to offer any new services? A few years ago our institution started performing open heart surgeries. We did not increase our Blood Bank staff, but the workload gradually increased to an almost-unbearable level. Historically, we have had great difficulties in recruiting new staff when openings occured. Our Lab Administrative Director looked at the number of "baby-boomer" staff due to retire in the next few years (and the predicted decreasing number of new gratuates entering the field), and saw that automation was the best answer to meet both our current and future needs.

When you are presenting the cost analysis aspect, demonstrate how automation can help you take on significant workload in the future without an increase in staff. Regarding staff, don't forget to consider the cost of employee benefits, coverage during vacations, etc. (We don't grant our Echo any vacation!)

(We don't grant our Echo any vacation!)

Well, I think that is very cruel!

We granted our ECHO every vacation it requested in writing in triplicate just like everyone else.

Love it John!!!!!!!!!!

Ours is getting its annual vacation day today with a spa day provided by Immucor. Its going to have it's its tubing changed and all sorts of other lovely exciting procedures. I expect it to be well rested and working 110% tomorrow.

Ours is getting its annual vacation day today with a spa day provided by Immucor. Its going to have it's its tubing changed and all sorts of other lovely exciting procedures. I expect it to be well rested and working 110% tomorrow.

You know, I really don't think you're taking this seriously!!!!!!!!!

:rolleyes::rolleyes:

Thanks everyone- now I know where i've been going wrong- haven't been talking to,stroking and giving my analysers any treats.

Do you guys celebrate xmas and birthdays with them too?