A transfusion medicine physician in Florida reports that his facility is part of a system wide network of hospitals that share the exact same clinical and laboratory information systems and essentially identical transfusion service procedures. Although the laboratories in the hospitals all have different laboratory directors, one pathologist has "system-wide responsibility for the transfusion services". The network recently added an 'outlying' community hospital that has become the source of increased numbers of patient transfers to his hospital, and he is interested to know if it would be allowed for these very sick patients to be transferred along with their crossmatched/reserved/ordered but not yet transfused RBC units, given that both hospitals share the exact same computer system and the exact same patient data base. He also wonders if it would be allowed to transfer previously drawn compatibility specimens that have not yet expired and that are otherwise acceptable for use for additional crossmatches? He wonders if there are any regulatory or accreditation agencies that would prohibit the transfer and use of either the crossmatched RBC units or the compatibility samples between the facilities?

1. Editor's note: Colleagues may find the information at:

• Transporting Blood With Patients and
• Management of Compatibility Testing When a Patient is Transferred To Another Hospital Sharing the Same Transfusion Service SOPs and Computer System

to be germane to this discussion.

The following comments have been received.

ADDENDA May 14, 2005

2. A Transfusion Service Technical Supervisor in Nebraska reports that she works at a hospital that has two locations (East and West) which are separated by more than three miles. She reports that these two locations share the same institutional (hospital) license. She supervises the transfusion services at both locations, but spends more of her time at the West location because that is where they perform immunohematology problem workups and new employee training. Each lab location has its own CLIA license and is separately inspected by the College of American Pathologists (CAP), although the AABB inspects both laboratories during a single assessment. Even though the East and West locations are physically separated, they function as in an integrated fashion, with both locations using the same unique Medical Record Numbers, so that when a patient moves between the East and West locations, it is considered no different than the patient moving between floors of the same building. The two sites use the same written procedures, have the same account with their blood supplier, and use the same people to supervise the Transfusion Services. The JCAHO assesses the East and West locations during a single inspection. Because of the close relationship of the East and West locations, crossmatched blood and specimens are routinely shuttled between these two locations. Crossmatching is routinely done at the West location, although the East location does quite a bit of its own crossmatching for STATS, when necessary. When the West location does crossmatching for the East, the compatibility tags print out at the East location. The computer system documents which location (East or West) did the testing. The technologists rotate between locations, as needed, and if an instrument is down at one location, the testing can be sent to the other location for backup. Finally, the patient gets one bill, even though they may have been moved between locations for a "procedure".

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Ira A. Shulman, MD
CBBS e-Network Forum Editor & Moderator