Reducing blood sample hemolysis at a tertiary hospital emergency department.
OBJECTIVE
To determine the causes for sample hemolysis and measure the effect of an intervention to reduce sample hemolysis in the Emergency Department of a large hospital.


METHODS
We conducted a phased, prospective, interventional study. In phase 1, factors associated with urea and electrolyte sample lysis were studied. Based on these results and a literature review, an educational program consisting of a 15-minute presentation was implemented. In phase 2, questionnaires were distributed to the doctors and medical students conducting blood sampling, and outcome data were collected after the samples were processed.


RESULTS
In phase 1 (n = 227), the use of a vacutainer was associated with the highest rates of hemolysis. Lysis rate was 35.8% with use of the vacutainer, compared with 11% without (adjusted odds ratio 6.0, 95% confidence interval, 2.3-15.2). In phase 2 (n=204), the following significant changes were found: increased use of a syringe rather than vacutainer (before 64.3%; after 98.5%, P <.01), increased use of venipuncture for blood sampling (26%-36.8%, P = .02), reduced arterial sampling (3.1%-0%, P = .02), increased sample volume (4.5-5.2 mL, P <.01) and reduced interval from sampling to analysis (60.8-48.4 minutes, P <.01). We were able to attain a reduction in sample hemolysis from 19.8% (before) to 4.9% (after) (P <.001). This would translate to a cost savings of SGD$834.40 (USD$556.30) per day at the emergency department and SGD$304,556 (USD$203,037) per year.


CONCLUSIONS
Introduction of an educational program at a hospital Emergency Department was able to significantly reduce rates of sample hemolysis.
Department of Emergency Medicine, Singapore General Hospital, Outram Road, Singapore 169608. marcus.ong.e.h@sgh.com.sg
Marcus Eng Hock
ME
Ong
Yiong Huak
YH
Chan
Chin Siah
CS
Lim
D001800:Blood Specimen Collection / Q000379:methods*; D004636:Emergency Service, Hospital; D006461:Hemolysis / Q000502:physiology*; D006801:Humans; D018962:Phlebotomy / Q000379:methods*; D011361:Professional Competence; D011446:Prospective Studies; D012846:Singapore; D013594:Syringes / Q000706:statistics & numerical data