Implementing a Phlebotomy Training Program to Decrease Troponin Hemolysis Rates in an Emergency Department

Hemolyzed troponin samples may delay diagnosis and treatment for patients presenting with a cardiac complaint. This project focused on decreasing hemolysis rates of troponin samples collected in the emergency department and increasing troponin sample collection by emergency room technicians in an urban academic medical center. This project aimed to evaluate the hemolysis rate of troponin samples collected by registered nurses and emergency room technicians working in the emergency department after completing a phlebotomy training program on best practices in blood specimen collection.

A quality improvement design was used to assess troponin hemolysis rates during the 12 weeks before and after the project implementation. Staff knowledge of factors that lead to hemolyzed blood specimens was assessed using a pre- and post-test. Educational in-service was provided to both emergency department technicians and registered nurses, and data analysis was performed to compare pre- and postproject implementation troponin hemolysis rates.

Overall departmental troponin hemolysis rates declined from 7.2% to 3.4%. Samples collected by emergency room technicians after the intervention had a 56% reduction, whereas samples collected by registered nurses had a 52% reduction in blood specimen hemolysis. Our analysis demonstrated a significant reduction in hemolysis among specimens drawn by registered nurses (P<.001). In contrast, emergency room technicians did not significantly reduce the number of hemolyzed specimens (P = .33); however, their involvement did result in a doubling of the total number of specimens drawn by emergency room technicians, which increased from 41 to 91 total samples collected.

Findings from this project support the use of a phlebotomy training program to educate staff on best practices in blood collection, which may contribute to a lower incidence of hemolyzed blood specimens. The findings also support the use of emergency room technicians in collecting troponin blood specimens within the ED setting.