Educational or organizational approach: which is more effective in changing blood-sampling habits?
Diagnostic blood loss is a recognized issue during the delivery of intensive care services. We designed this study to compare the effects of educational versus organizational approaches to reduce daily diagnostic blood loss in intensive care patients. First, as an educational approach, physicians on two wards were repeatedly informed about the importance of diagnostic blood loss and that 1.0-1.5 mL is sufficient for blood gas analysis. Second, as an organizational approach, 3-mL syringes were replaced by 2-mL syringes. Measurements after both periods were compared with a control group. The amount of drawn/discarded blood of 320 samples was measured in each group after the 2 interventions. Compared with the control group, the educational program reduced the amount of drawn/discarded blood in one ward, but not the other. After the organizational change, the amount of drawn/discarded blood was reduced in both wards. Additionally, because of the smaller costs of 2-mL syringes, implementation of 2-mL syringes saved US dollars 30800/yr in our hospital. In conclusion, our study shows that an educational program seems less effective in influencing physician behavior than organizational changes. Therefore, organizational changes should be favored over educational approaches whenever possible.


CONCLUSIONS
Organizational change is more effective than educational programs to reduce diagnostic blood loss. Organizational implementation of smaller syringes reduces the amount of discarded blood and can save money.
*Department of Anesthesiology and General Intensive Care, University of Vienna, Vienna, Austria; and †Ludwig Boltzmann Institute of Clinical Anesthesiology and Intensive Care, Vienna, Austria.
Christopher
C
Gonano
Christian
C
Sitzwohl
Franz
F
Pusch
Stephan C
SC
Kettner
Christian
C
Weinstabl
Michael
M
Zimpfer
D001315:Australia; D001784:Blood Gas Analysis; D003422:Critical Care / Q000941:ethics / Q000458:organization & administration*; D006184:Habits; D006801:Humans; D007362:Intensive Care Units / Q000458:organization & administration; D013048:Specimen Handling / Q000191:economics / Q000941:ethics / Q000379:methods*; D013594:Syringes