A Quality Improvement Cycle: Hemolyzed Specimens in the Emergency Department

Abstract

OBJECTIVE: To determine the cause of and possible solution for an excessive number of hemolyzed specimens received from the emergency department (ED) of a large medical center.

DESIGN: The clinical laboratory staff collected data on hemolyzed specimens for all departments of the medical center. The clinical laboratory management team and ED management team intervened with training and surveillance of the ED staff to heighten the awareness of the problem.

SETTING: The clinical chemistry laboratory of a large medical center.

MAIN OUTCOME MEASURE: The number of specimens submitted by inpatient departments and the ED was measured in relationship to the number of hemolyzed specimens received from the departments. The clinical laboratory measured specimen processing times and turnaround times to determine their role in possibly contributing to the large number of hemolyzed specimens. Direct observation by a certified phlebotomist documented anecdotal evidence of the ED staff's phlebotomy practices. ED and clinical laboratory practitioners communicated realistic impressions of the medical centers problem with hemolyzed specimens.

RESULTS: The laboratory processing times were not responsible for the hemolyzed specimens. The collection equipment was not responsible for the hemolyzed specimens. The ED had an excessive number of hemolyzed specimens when compared to the rest of the medical center. The collection techniques in the ED appeared to be the origin of the problem.

CONCLUSION: The intervention of the laboratory manager with the ED chief and nurse manager abated some of the professional arrogance between the departments. The dialogue educated the staffs about specific data that pointed to a possible origin of the problem. The ED chief placed his department on surveillance against problematic draws. Communication was improved between the two departments. However, only a moderate improvement in the number of hemolyzed specimens was noted. More training of medical center departments in phlebotomy and periodic proficiency evaluation of the all staff was indicated as a possible long-term solution.

ABBREVIATIONS: CLT = clinical laboratory technician; CLS = clinical laboratory scientist; ED = emergency department; HIS = hospital information system; LIS = laboratory information system; RBC = red blood cells; SOP = standard operating procedure; TAT = turnaround time.