Reducing blood sample hemolysis at a tertiary hospital emergency department
Open accessAbstract
Purpose To determine the causes for sample hemolysis and measure the effect of an intervention to reduce sample hemolysis in the Emergency Department of a large hospital.Methods We conducted a phased, prospective, interventional study. In phase 1, factors associated with urea and electrolyte sample lysis were studied. Based on these results and a literature review, an educational program consisting of a 15-minute presentation was implemented. In phase 2, questionnaires were distributed to the doctors and medical students conducting blood sampling, and outcome data were collected after the samples were processed.Results In phase 1 (n = 227), the use of a vacutainer was associated with the highest rates of hemolysis. Lysis rate was 35.8% with use of the vacutainer, compared with 11% without (adjusted odds ratio 6.0, 95% confidence interval, 2.3-15.2). In phase 2 (n=204), the following significant changes were found: increased use of a syringe rather than vacutainer (before 64.3%; after 98.5%, P <.01), increased use of venipuncture for blood sampling (26%-36.8%, P = .02), reduced arterial sampling (3.1%-0%, P = .02), increased sample volume (4.5-5.2 mL, P <.01) and reduced interval from sampling to analysis (60.8-48.4 minutes, P <.01). We were able to attain a reduction in sample hemolysis from 19.8% (before) to 4.9% (after) (P <.001). This would translate to a cost savings of SGD$834.40 (USD$556.30) per day at the emergency department and SGD$304,556 (USD$203,037) per year.Conclusions Introduction of an educational program at a hospital Emergency Department was able to significantly reduce rates of sample hemolysis.
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- Authors
- Ong, M. E. H., Chan, Y. H., & Lim, C. S.
- Affiliations
- Singapore General Hospital (SG)
- National University of Singapore (SG)
- Corresponding author
- Ong, Marcus Eng Hock
- Venue
- The American Journal of Medicine
- Publisher
- Elsevier BV
- Published
- 2009-11
- Volume
- 122
- Issue
- 11
- Pages
- 1054.e1-1054.e6
- ISSN
- 0002-9343 (ISSN-L)
- OpenAlex
- W1990870034
- Semantic Scholar
- b739953aae79911ebe50a78c44a69f3625958885
- Cited by
- 37
- References
- 16
- Citations by year
- 2024: 3 · 2023: 1 · 2022: 2 · 2021: 1 · 2020: 2 · 2019: 4 · 2018: 3 · 2017: 3 · 2016: 4 · 2015: 4 · 2014: 2 · 2013: 3 · 2012: 3
- FWCI
- 1.10
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- The American Journal of Medicine (publishedVersion)
- PubMed (publishedVersion)
- Funders
- University of Glasgow
- Universität Ulm
- Topics
- Health Sciences › Medicine › Physiology › Clinical Laboratory Practices and Quality Control
- Health Sciences › Health Professions › Emergency Medical Services › Patient Safety and Medication Errors
- Health Sciences › Health Professions › General Health Professions › Healthcare cost, quality, practices
- Keywords
- emergency department, venipuncture, Vacutainer, arterial blood sampling, sample volume, employee training, cost reduction, laboratory quality improvement
- MeSH terms
- Blood Specimen Collection, Emergency Service, Hospital, Hemolysis, Humans, Professional Competence, Prospective Studies, Singapore, Syringes, Phlebotomy
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