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The Hidden Cost of Hemolyzed Blood Samples in the Emergency Department
Michael P Phelan1, Christopher Ramos2, Laura E Walker3
1Emergency Services Institute, Cleveland Clinic Health System, Cleveland, OH, USA.
Insights
Poor-quality blood samples in the emergency department (ED) lead to significant costs. Hemolyzed potassium samples increase patient length of stay by 1 hour, costing millions annually.
Area of Science:
- Clinical Chemistry
- Healthcare Economics
- Laboratory Quality Management
Background:
- Poor-quality preanalytic blood samples, specifically hemolyzed potassium samples, are a common issue in emergency departments (EDs).
- These suboptimal samples can lead to extended patient stays, irrespective of clinical severity or disposition.
- Quantifying the direct financial impact of these preanalytic errors is crucial for healthcare cost analysis.
Purpose of the Study:
- To quantify the direct financial expenses associated with poor-quality preanalytic blood samples collected in the ED.
- To estimate the cost impact of hemolyzed samples on healthcare resource utilization.
Main Methods:
- Developed a cost model using a range of direct expenses per bed-hour, informed by literature and inflation-adjusted values.
- Incorporated a range of hemolysis incidence rates based on previously reported data.
- Calculated the estimated annual cost impact for an ED with a specified number of annual visits and routine chemistry draw rates.
Main Results:
- An ED with 100,000 annual visits, a 40% routine chemistry draw rate, and a 10% hemolysis incidence experiences direct costs of approximately $4 million per year.
- This significant cost is primarily driven by an average 1-hour increase in length of stay for patients with hemolyzed blood samples.
- The findings highlight the substantial financial burden of avoidable extended ED stays due to sample quality issues.
Conclusions:
- The financial burden of poor-quality blood samples can be effectively estimated using cost per bed-hour and sample failure rates.
- This methodology can be applied to identify and quantify the financial implications of other quality control issues in laboratory diagnostics.
- Addressing preanalytic sample quality is essential for optimizing healthcare costs and improving patient flow in the ED.
Background:
On average, patients with hemolyzed potassium samples spend about 1 h longer in the emergency department (ED), regardless of acuity level or disposition. We aimed to quantify the direct expenses associated with poor-quality preanalytic blood samples collected in the ED.
Methods:
We created a simple table with a range of direct expenses (i.e., costs) and rates of hemolyzed sample draws, allowing for identification of potential high-level cost-of-care impact analysis. We included a range of costs informed by review of literature on the topic. Those costs range from $600 to $3000 per bed-hour. This amount was inflation adjusted from 1996 to 2020 (1.68 × [direct cost per visit] × [100 000 visits per year/365 days/24 h]). We provided a range of hemolysis incidence based on previously reported data.
Results:
We showed that for an ED with 100 000 annual visits, a 40% draw rate for routine chemistries (including potassium), and a 10% hemolysis incidence, the direct cost impact of hemolysis waste is approximately $4 million/year as a result of the 1 h of added length of stay on average for a patient with a hemolyzed blood sample. This amount represents an annualized estimated cost of caring for a patient in the ED with an avoidable extended length of stay.
Conclusions:
The financial burden of poor-quality blood samples can be estimated using cost per bed-hour and rate of sample failure. Similar methodology may identify additional QC issues with previously invisible financial implications.
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