From the emergency department (ED) to the laboratory, unite the diagnostic pathway

Unite the diagnostic pathway, from the emergency department (ED) to the laboratory

When most testing errors occur outside of the lab,1 how can we bridge the gaps along the diagnostic pathway?

From patient triage to diagnostic testing, sample quality can be impacted at any stage of the journey. Specimen non-conformities at one stage can be carried into the next, and you don't always have the visibility to know where to trace the source of haemolysis or contamination before they become non-conforming samples or false-negative/positive results.

EDs are working to mitigate increasing sample volumes, staff shortages and high workloads while maintaining sample quality, turnaround times and patient safety before they impact the laboratory.1

If diagnostic errors can be carried from the preanalytical phase onward, then so can quality. Let's work together to build bridges within and between departments to allow sample quality to flow between the ED and the laboratory, from collection to results.

CAUTI costs

In ED 67% of patients have at least 1 laboratory test.1

CAUTI costs

Up to 70% of all erroneous results are caused by mistakes within the preanalytical phase process, potentially resulting in misdiagnosis or inappropriate clinical treatment.2

10 %

One study found that 6% of all samples in the ED are rejected, meaning repeat phlebotomy may be needed, causing diagnostic delays.3,4

Bacteria

Fewer than half of EDs use turnaround time (TAT) as a quality indicator.1

Bacteria

Haemolysis is the most common preanalytical error, accounting for 65% of rejected ED samples.5,6

New preanalytical guidelines: Improving ED blood sampling

The European Society for Emergency Medicine (EUSEM), the European Society for Emergency Nursing (EuSEN) and the European Federation of Clinical Chemistry and Laboratory Medicine (EFLM), with the support of BD via an unrestricted educational grant, devised a multidisciplinary working group to identify key recommendations for preanalytical phase process, from patient identification to blood sampling, transportation and preanalytical monitoring.

Discover the key highlights and download the guidelines:

ACCESS THE GUIDELINES

Your emergency department may need a check-up.

Discover the new recommendations.

Haemolysis is one of the quality limitations of the testing process, with sampling techniques a major contributor.4 Hospital EDs have been identified as the setting with the highest source of haemolysed blood samples, its therefore important to take appropriate steps to reduce the rate of haemolysis because of its many consequences.4, 7

Haemolysis rates are shown to be higher in samples taken from catheters vs those taken by vein punctures using straight or butterfly needles.8

Recommendation:
In the ED, venipuncture using needles rather than drawing blood from a PIVC is recommended to minimise the frequency of phlebotomy-related haemolysis.4
If after a risk analysis blood is drawn from a PIVC, the professional should use a low vacuum system, to reduce the risk of haemolysis.4

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In the EU context, blood sampling in the ED is performed by different professionals with different training backgrounds4 , with nurses most commonly responsible for the procedure.9
Training programmes for different professions show great variability4, therefore continuing education and training to raise awareness of the correct sampling procedure is important to minimise the risk of sample rejection.10

Recommendation:
In the ED blood sampling in the adult patients should be performed by specifically trained healthcare professionals4. Considering the patient workflow.4

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Preanalytical errors have the potential to adversely affect the quality of laboratory test results with studies estimating that 26% of these variables may result in unnecessary investigations or inappropriate treatment.11

Specimen rejection because of preanalytical errors causes delays, ultimately leading to prolonged length of stay at the ED.4

Recommendation:
Including turnaround time as a KPI for ED laboratory processes.4

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Attempts to reduce errors should begin with a review of the sources of these errors.4 The most frequently causes of preanalytical errors are haemolysis, incorrect patient identification, insufficient sample volume, and clotted specimens.12

ED and laboratory staff need to be aware of the critical importance of quality assurance in the preanalytical and analytical phases of blood sample processing for patients in the ED.4

Recommendation:
The selection and implementation of quality indicators/key performance indicators to support the ED and laboratory teams in improving the preanalytical, analytical and postanalytical process of ED blood samples such as:4

  • Blood culture contamination rate
  • Incidence rate of duplicate tests
  • Rejection rates and causes, such as haemolysis, underfilling and clotting

DISCOVER SOLUTIONS

 
  1. Placeholder Sampling
  2. Placeholder Training
  3. Placeholder Turnaround Time
  4. Placeholder Quality Management

Sample quality is the result of a lot of little things working together.

Your challenges aren't isolated - meeting them with resilient solutions and teams that work with your diagnostic workflow, between and within departments, can help set you on the road to diagnostic excellence.

Preventing Haemolysis

 Professional Services

 Managing turnaround time

The BD Vacutainer® UltraTouch™ Push Button Blood Collection Set provides a faster blood collection experience without compromising diagnostic testing accuracy and supports you to obtain blood from patients with DVA without utilising an indwelling catheter.13,14

  • 40% potential reduction in risk of haemolysis13
  • 3% reduction in rates of underfilled tubes13*
  • 50% reduction of tube fill times with 23G15**

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Studies have shown low vacuum tubes are effective in reducing haemolysis when drawing blood from IV catheters.16,17 Specifically within the ED the adoption of BD Vacutainer® Barricor™ Tubes with reduced vacuum has led to reduced haemolysis rates.18,19

Partial-draw tubes providing a low vacuum are available for our core tube families to support you in reducing the risk of haemolysis if (following risk analysis) blood is drawn from a PIVC.


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Our BD Professional Services team can support you to help reduce your rate of haemolysis with a range of services including:

  • Best practice and preanalytical variables training (e-learning or in person)
  • Conducting a value gap assessment of your sample workflow (from the ED to the laboratory) with our PreAnalytical Quality Check (PAQC) service

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Explore the full range

With products to suit the needs of the Emergency Department and Laboratory to help ensure quality at every stage of the preanalytical phase process and beyond.

BD Vacutainer® venous blood collection system: Full range of tubes and venous access devices to meet any laboratory and patient population needs.

BD Vacutainer® closed urine collection system: Aims to reduce mixed growth and contaminated samples to save costs, time and diagnostic and treatment delays.

BD arterial blood collection system: Helps to provide clinically superior and safe solutions to standardise collection of arterial samples dedicated to critical care panel testing.

BD Vacutainer® blood collection devices and accessories: Additional products to support blood collection including the Luer-Lok™ Access Device for when risk assessed catheter collections are needed.

BD Microtainer® capillary collection system: A complete solution designed and developed for your most fragile patients.

BD blood culture media solutions: Aims to improve clinical performance and workflow efficiencies, from specimen collection to actionable results.

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The power of integrated specimen management

Discover how the laboratory of the University Hospital of Reims, France mitigated preanalytical errors in high throughput testing by partnering with BD Professional Services to evaluate their diagnostic workflows and implement quality-driven solutions.


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