Current Methods of Haemolysis Detection and Reporting as a Source of Risk to Patient Safety: a Narrative Review.
OBJECTIVE
Haemolysis has a major impact on patient safety as the need for a replacement specimen increases the risk of injury and infection, delays test results and extends the duration of hospital stays. Consistency of haemolysis detection and reporting can facilitate the generation of benchmark data used to develop quality practices to monitor and reduce this leading cause of pre-analytical laboratory error. This review aims to investigate current methods of haemolysis detection and reporting.


METHODS
Due to known heterogeneity and immaturity of the research field, a scoping search was conducted using PUBMED, Embase, Medline and CINAHL. Articles published between 2000 and 2014 that reported haemolysis rates in specimens from the general population were included.


RESULTS
Of the 50 studies that met the inclusion criteria, 20 detected haemolysis using the Haemolysis Index (HI), 19 by visual inspection and 13 by undefined methods. There was large intra-study variation in the plasma free haemoglobin level used to establish haemolysis (HI: mean±SD 846±795 mg/L, range 150-3000 mg/L; Visual: 850±436 mg/L, 500-3000 mg/L). Sixteen studies reported the analyte of interest, with only three studies reporting a haemoglobin level at which the specimen would be rejected.


CONCLUSIONS
Despite haemolysis being a frequent and costly problem with a negative impact on patient care, there is poor consistency in haemolysis detection and reporting between studies. Improved consistency would facilitate the generation of benchmark data used to create quality practices to monitor and reduce this leading cause of pre-analytical laboratory error.
Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Macquarie University, North Ryde, NSW, 2109, Australia.
Euan J
EJ
McCaughey
Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Macquarie University, North Ryde, NSW, 2109, Australia;; South Eastern Area Laboratory Services, NSW Health Pathology, Prince of Wales Hospital, Randwick, NSW, 2031, Australia.
Elia
E
Vecellio
Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Macquarie University, North Ryde, NSW, 2109, Australia.
Rebecca
R
Lake
Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Macquarie University, North Ryde, NSW, 2109, Australia.
Ling
L
Li
South Eastern Area Laboratory Services, NSW Health Pathology, Prince of Wales Hospital, Randwick, NSW, 2031, Australia;; Pathology North, NSW Health Pathology, Royal North Shore Hospital, St Leonards, NSW, 2065, Australia;; Northern Clinical School, Sydney Medical School, University of Sydney, NSW, 2006, Australia.
Leslie
L
Burnett
Pathology North, NSW Health Pathology, Royal North Shore Hospital, St Leonards, NSW, 2065, Australia;; Northern Clinical School, Sydney Medical School, University of Sydney, NSW, 2006, Australia.
Douglas
D
Chesher
Pathology North, NSW Health Pathology, Royal North Shore Hospital, St Leonards, NSW, 2065, Australia;; Pathology North, NSW Health Pathology, Newcastle, NSW, 2300, Australia.
Stephen
S
Braye
Pathology North, NSW Health Pathology, Royal North Shore Hospital, St Leonards, NSW, 2065, Australia;; Royal College of Pathologists Australasia Quality Assurance Program, St Leonards, NSW, 2065, Australia.
Mark
M
Mackay
Royal College of Pathologists Australasia Quality Assurance Program, St Leonards, NSW, 2065, Australia.
Stephanie
S
Gay
Royal College of Pathologists Australasia Quality Assurance Program, St Leonards, NSW, 2065, Australia.
Tony C
TC
Badrick
Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Macquarie University, North Ryde, NSW, 2109, Australia.
Johanna I
JI
Westbrook
Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Macquarie University, North Ryde, NSW, 2109, Australia.
Andrew
A
Georgiou