Phlebotomists on Emergency Department Performance: A Retrospective Comparative Study

Emergency departments (ED) in Australia have experienced an increase in patient presentations. To address this demand, we introduced phlebotomists at ED triage seeking to reduce ED waiting and disposition times. We report the impact of this intervention.

Using a quantitative retrospective comparative study design guided by the STROBE checklist, we investigated the impact on ED performance before and after the introduction of phlebotomists (the intervention). Data from two periods-T1 (January-June 2021) and T2 (January-June 2023) were obtained and analysed for all ED presentations.

A total of 90,020 patients were included (T1: 46,639; T2: 43,381). Post-intervention improvements included an increase in short stay unit-admissions from triage (3.1% vs. 5.9%, p < 0.001) and a decrease in the proportion of patients transferred to a cubicle from the waiting room (T1: 78.8%; T2: 76.4%). However, patients who left the ED before treatment was completed (known as 'Did not Wait') rose significantly (9.8% vs. 11.5%) as did waiting room times (80.02 vs. 112.91 min). Overall, ED length of stay (EDLOS) increased significantly (mean T1: 305.1 to T2: 319.4 min; p < 0.001). There were significant increases in blood tests (T1: 52.0% vs. T2: 59.9%) and ECGs (16.5% vs. 19.1%) performed.

The introduction of phlebotomists at triage failed to reduce waiting, treatment and disposition times and increased the number of investigations performed with an overall increase in EDLOS. We observed an increase in the number of patients directed from the waiting room to the short stay unit and fewer patients transferred from the waiting room to an ED cubicle.