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A quality improvement cycle: hemolyzed specimens in the emergency department
Lester Pretlow1, Terry Gandy, Elizabeth Kenimer Leibach
1Department of Biomedicaland Radiological Technologies, EC-3338, Medical College of Georgia, Augusta, GA 30912-0500, USA. lpretlow@mcg.edu
Insights
Improper blood collection techniques in the emergency department (ED) caused excessive hemolyzed specimens. Interventions improved communication but required further phlebotomy training and evaluation for lasting solutions.
Area of Science:
- Clinical Laboratory Science
- Medical Diagnostics
- Phlebotomy Best Practices
Background:
- Excessive hemolyzed specimens from the emergency department (ED) pose a significant challenge in medical centers.
- Hemolysis can compromise the accuracy of laboratory test results, impacting patient care.
Purpose of the Study:
- To identify the root cause of a high incidence of hemolyzed specimens originating from the ED.
- To implement and evaluate solutions to reduce hemolysis rates in ED blood collections.
Main Methods:
- A comparative analysis of hemolysis rates across hospital departments was conducted.
- Phlebotomy practices in the ED were observed, and specimen processing times were evaluated.
- Interdisciplinary training and surveillance were implemented involving laboratory and ED staff.
Main Results:
- Laboratory processing times and collection equipment were ruled out as causes of hemolysis.
- The emergency department exhibited a significantly higher rate of hemolyzed specimens compared to other departments.
- Phlebotomy techniques employed by ED staff were identified as the primary source of the problem.
Conclusions:
- Interdepartmental communication and targeted interventions initially improved the situation but yielded only moderate success.
- Enhanced phlebotomy training and ongoing proficiency assessments for all medical center staff are recommended for long-term reduction of hemolyzed specimens.
Objective:
To determine the cause of and possible solution for an excessive number of hemolyzed specimens received from the emergency department (ED) of a large medical center.
Design:
The clinical laboratory staff collected data on hemolyzed specimens for all departments of the medical center. The clinical laboratory management team and ED management team intervened with training and surveillance of the ED staff to heighten the awareness of the problem.
Setting:
The clinical chemistry laboratory of a large medical center.
Main Outcome Measure:
The number of specimens submitted by inpatient departments and the ED was measured in relationship to the number ofhemolyzed specimens received from the departments. The clinical laboratory measured specimen processing times and turnaround times to determine their role in possibly contributing to the large number of hemolyzed specimens. Direct observation by a certified phlebotomist documented anecdotal evidence of the ED staffs phlebotomy practices. ED and clinical laboratory practitioners communicated realistic impressions of the medical centers problem with hemolyzed specimens.
Results:
The laboratory processing times were not responsible for the hemolyzed specimens. The collection equipment was not responsible for the hemolyzed specimens. The ED had an excessive number ofhemolyzed specimens when compared to the rest of the medical center. The collection techniques in the ED appeared to be the origin of the problem.
Conclusion:
The intervention of the laboratory manager with the ED chief and nurse manager abated some of the professional arrogance between the departments. The dialogue educated the staffs about specific data that pointed to a possible origin of the problem. The ED chief placed his department on surveillance against problematic draws. Communication was improved between the two departments. However, only a moderate improvement in the number of hemolyzed specimens was noted. More training of medical center departments in phlebotomy and periodic proficiency evaluation of the all staff was indicated as a possible long-term solution.