Communication gap between blood bank and treating doctor

One Sankalp volunteer narrates an incident where lack of proper co-ordination and poor decision making put a family searching for blood through extreme moments of trauma. 

One evening we received a blood request from northern part of the state on our state-wide helpline for blood. The blood group was AB+ (not much rare), but no blood banks in the district had the stocks of this blood group available to them. The request was forwarded to Sankalp’s emergency team which swung into action. As usual, the team spoke to the family to try and understand the situation.

The patient was about to deliver and her hemoglobin has 6.7 g/dl. The doctor had asked the family to organize 3 units of blood. Only one unit was available in the blood banks but there were several options that were available to the family. While the systematic search for blood donors in the vicinity was one option, a unit of the same group was available in the nearby district which could have been brought in. The situation was tough but not unmanageable. But the situation turned out to be exceptionally tense due to lack of good understanding between the blood banks and the treating doctor.

The treating doctor instructed the family to immediately product 3 units of blood or else transport the patient to Hyderabad (couple of hours away). It was clear that 3 units can’t be produced at a few minutes’ notice. But the doctor was not willing to listen to anything. She believed that if blood is not available on time the delivery could get complicated.

Though one donor was found very quickly, the doctor was pressurizing the family to take the patient to some other place. The blood bank staff kept communicating to us that they can do a spot test and issues the unit in one hour if the doctor instructs that the need was urgent. However, the doctor refused to issue an urgent request and kept telling that donation will take several hours.

One unit of blood was available in the nearby district. The family requested the doctor for a second request slip which could be taken to the other blood bank to get blood. The expected time to collect the unit from the nearby district was 3 hours in total. With 2 units available locally, this could have been easily managed. But the doctor was unwilling to even allow the unit to be brought in from the nearby district.

In summary, the doctor thought that blood will not be arranged soon enough and was keen on seeing the patient transported at a critical stage to Hyderabad instead of discussing and cooperating with the local blood bank to make arrangements there itself. The blood bank was very willing to leverage their skill to see to it that the blood is available but the communication with the doctor was routed through the family leading to inadequate clarity and understanding. In the midst of this situation, it was the patient’s family which suffered the most.

This request was one of the many which highlight the need for active communication between the blood bank and the treating doctors. Had the doctor taken the direct opinion of the blood bank on how to organize blood and had the blood bank officer explained the best option, maybe the doctor would have understood the situation a little better than what the family members were able to communicate. Active communication between the doctors and blood banks could build a relationship of trust and dependability which will go a long way in ensuring better care for the patients.

If you are a blood banker, we appeal to you to take the extra initiative of sitting with the clinicians who treat the patients you supply blood to and help enhance their understanding on what to expect and what to do at the time of emergency requirement of blood. Such discussions will go a long way in ensuring better response to the emergency requests for blood