Reducing Blood Sample Hemolysis at a Tertiary Hospital Emergency Department - 12/08/11
, Yiong Huak Chan, PhD b, Chin Siah Lim, MBBS a
Requests for reprints should be addressed to Marcus Ong Eng Hock, MBBS, MPH, Department of Emergency Medicine, Singapore General Hospital, Outram Road, Singapore 169608Abstract |
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.
Le texte complet de cet article est disponible en PDF.Keywords : Chemistry testing, Emergency department, Sample hemolysis, Venipuncture, Venous cannulation
Plan
| Funding: None. |
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| Conflict of Interest: All authors have no commercial associations or sources of support that might pose a conflict of interest. |
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| Authorship: All authors had full access to all the data in the study. Drs. Ong and Lim conceived the study objectives and methodology, and prepared the study protocols. Dr. Chan provided statistical advice and analyzed the data. Dr. Lim managed the data collection and database, and the administration of the study. Dr. Ong drafted the manuscript, and all authors contributed to the final manuscript. |
Vol 122 - N° 11
P. 1054.e1-1054.e6 - novembre 2009 Retour au numéro
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