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Impact of Phlebotomy Volume Knowledge on Provider Laboratory Ordering and Transfusion Practices in the Pediatric
Gary A LaCroix1, David A Danford1,2, Amanda M Marshall1,2
1Department of Cardiology, University of Nebraska Medical Center, Omaha, NE.
Insights
Implementing an electronic medical record (EMR) phlebotomy volume display significantly reduced laboratory sampling and costs in pediatric cardiac intensive care units (CICUs). This intervention improved patient care by minimizing unnecessary blood draws without adverse outcomes.
Area of Science:
- Pediatric Cardiology
- Critical Care Medicine
- Health Informatics
Background:
- Phlebotomy contributes to significant blood loss in pediatric cardiac surgery patients.
- Accurate estimation of phlebotomy volume is challenging for healthcare providers.
Purpose of the Study:
- To evaluate the effectiveness of an electronic medical record (EMR) phlebotomy volume display in reducing laboratory sampling and blood transfusions.
- To analyze the cost-effectiveness of implementing this EMR display.
Main Methods:
- A prospective interrupted time series quality improvement study was conducted in a pediatric cardiac intensive care unit (CICU).
- An EMR phlebotomy volume display, including a calculated maximal phlebotomy volume, was implemented.
- Cross-sectional surveys assessed provider knowledge and perceptions pre- and post-intervention.
Main Results:
- Mean laboratory draws per patient per day decreased from 9.5 to 2.5 (p=0.005).
- Mean phlebotomy volume per patient decreased from 30.9 to 14.4 mL (p=0.038).
- No increase in blood transfusions, CICU length of stay, or adverse patient outcomes was observed. Costs for laboratory studies showed a downward trend.
Conclusions:
- Healthcare providers often inaccurately estimate phlebotomy volumes.
- A well-designed EMR phlebotomy display effectively reduces laboratory sampling and associated costs in pediatric CICUs.
- The intervention demonstrated positive impacts on resource utilization without compromising patient safety.
Objectives:
Phlebotomy can account for significant blood loss in post-surgical pediatric cardiac patients. We investigated the effectiveness of a phlebotomy volume display in the electronic medical record (EMR) to decrease laboratory sampling and blood transfusions. Cost analysis was performed.
Design:
This is a prospective interrupted time series quality improvement study. Cross-sectional surveys were administered to medical personnel pre- and post-intervention.
Setting:
The study was conducted in a 19-bed cardiac ICU (CICU) at a Children's hospital.
Patients:
One hundred nine post-surgical pediatric cardiac patients weighing 10 kg or less with an ICU stay of 30 days or less were included.
Interventions:
We implemented a phlebotomy volume display in the intake and output section of the EMR along with a calculated maximal phlebotomy volume display based on 3% of patient total blood volume as a reference.
Measurements And Main Results:
Providers poorly estimated phlebotomy volume regardless of role, practice setting, or years in practice. Only 12% of providers reported the availability of laboratory sampling volume. After implementation of the phlebotomy display, there was a reduction in mean laboratories drawn per patient per day from 9.5 to 2.5 ( p = 0.005) and single electrolytes draw per patient over the CICU stay from 6.1 to 1.6 ( p = 0.016). After implementation of the reference display, mean phlebotomy volume per patient over the CICU stay decreased from 30.9 to 14.4 mL ( p = 0.038). Blood transfusion volume did not decrease. CICU length of stay, intubation time, number of reintubations, and infections rates did not increase. Nearly all CICU personnel supported the use of the display. The financial cost of laboratory studies per patient has a downward trend and decreased for hemoglobin studies and electrolytes per patient after the intervention.
Conclusions:
Providers may not readily have access to phlebotomy volume requirements for laboratories, and most estimate phlebotomy volumes inaccurately. A well-designed phlebotomy display in the EMR can reduce laboratory sampling and associated costs in the pediatric CICU without an increase in adverse patient outcomes.
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