Reducing Blood Sample Hemolysis at a Tertiary Hospital Emergency Department

PURPOSE: 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. (C) 2009 Elsevier Inc. All rights reserved. . The American Journal of Medicine (2009) 122, 1054. e1-1054.e6