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Seeing Red: Blood Sample Hemolysis Is Associated with Prolonged Emergency Department Throughput.

Michael P Phelan1, Fredric M Hustey1, Daniel M Good2

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|July 1, 2020
PubMed
Summary

Hemolyzed blood samples in the emergency department (ED) significantly prolong patient length of stay (LOS) by an average of 62 minutes. This delay impacts both admitted and discharged patients, regardless of acuity.

Keywords:
Emergency Medicinehemolysispoor samplepre-analyticalreworkthroughputwaste

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Area of Science:

  • Clinical Pathology
  • Healthcare Operations

Background:

  • Hemolyzed blood specimens are a significant problem in emergency departments (EDs), leading to substantial burdens on patient care delivery.
  • The ED experiences the highest incidence of sample hemolysis compared to other hospital departments.

Purpose of the Study:

  • To assess the association between hemolyzed blood samples and patient throughput time in the ED.
  • To evaluate the impact of hemolysis on emergency department length of stay (LOS) as the primary outcome.

Main Methods:

  • Secondary analysis of data from a performance improvement project focused on reducing ED specimen hemolysis.
  • Electronic medical records were queried for potassium results and patient throughput time points.
  • Throughput times were stratified by hemolysis status, ED disposition, and Emergency Services Index (ESI) triage level; two-tailed t tests were used for comparison.

Main Results:

  • A total of 11,228 patient visits were analyzed.
  • Mean ED LOS was 62 minutes longer for patients with hemolyzed samples (349 minutes) versus non-hemolyzed samples (287 minutes).
  • Increased LOS associated with hemolysis was independent of ESI triage levels and patient disposition (admitted vs. discharged).

Conclusions:

  • Hemolysis of blood samples in the ED is directly associated with prolonged patient throughput.
  • Delays in patient disposition due to hemolysis occur irrespective of patient acuity markers like triage category or ultimate disposition.