"Rainbow Draws" in the Emergency Department: Clinical Utility and Staff Perceptions.

Area of Science:

• Clinical Pathology
• Laboratory Medicine
• Emergency Medicine

Background:

• The
• rainbow draw
• practice of collecting multiple blood tubes in emergency departments (EDs) is common but lacks robust supporting data.
• Limited evidence exists regarding the actual utilization and necessity of this practice.
• Staff perceptions of the rainbow draw's utility often contrast with objective data.

Purpose of the Study:

• To determine the actual utilization of blood tubes collected via the rainbow draw in an ED setting.
• To evaluate emergency department staff perceptions of the rainbow draw's utility.
• To identify discrepancies between perceived and actual blood tube usage to inform process improvements.

Main Methods:

• Analysis of blood tube utilization for initial and add-on testing over a 2-week period (1326 ED visits).
• Survey of ED staff regarding phlebotomy practices and test ordering perceptions.
• Comparison of objective utilization data with subjective staff survey responses.

Main Results:

• Fluoride/oxalate, citrate, and serum separator tubes were frequently discarded unused.
• The rainbow draw showed low utility for add-on testing and avoiding additional venipunctures.
• Objective data contrasted with staff perceptions, leading to process changes that reduced estimated blood waste by 175 L/year.

Conclusions:

• Aligning objective blood tube utilization data with ED staff perceptions can drive significant process improvements.
• Process changes based on data-driven insights reduced unnecessary blood collection and waste.
• The study's methodology is applicable to other institutions seeking to optimize phlebotomy practices.