umu.sePublications
Change search
CiteExportLink to record
Permanent link

Direct link
Cite
Citation style
  • apa
  • ieee
  • modern-language-association-8th-edition
  • vancouver
  • Other style
More styles
Language
  • de-DE
  • en-GB
  • en-US
  • fi-FI
  • nn-NO
  • nn-NB
  • sv-SE
  • Other locale
More languages
Output format
  • html
  • text
  • asciidoc
  • rtf
Haemolysis index: an estimate of preanalytical quality in primary health care!
Umeå University, Faculty of Medicine, Medical Biosciences, Clinical chemistry.
Umeå University, Faculty of Medicine, Medical Biosciences, Clinical chemistry.
Show others and affiliations
2009 (English)In: Clinical Chemistry and Laboratory Medicine, ISSN 1434-6621, E-ISSN 1437-4331, Vol. 47, no 8, p. 940-944Article in journal (Refereed) Published
Abstract [en]

Background: Haemolysis is usually caused by inadequate specimen collection or preanalytical handling, and is suggested to be a suitable indicator of preanalytical quality. We investigated the prevalence of detectable haemolysis in all routine venous blood samples to identify differences in preanalytical quality. Methods: Haemolysis index (HI) values were obtained from a Vitros 5,1 in the routine clinical chemistry laboratory for samples collected in primary health care centres (PHCs), nursing homes, and a hospital emergency department (ED). Haemolysis was defined as a HI ≥ 15 (detection limit). Results: Samples from the PHC with the highest prevalence of haemolysis were 6.1 times (95% confidence interval (CI) 4.0-9.2) more often haemolysed compared to the centre with the lowest prevalence. Of the samples collected in primary health care, 10.4% were haemolysed compared to 31.1% in the ED (p< 0.001). A notable difference in haemolysed samples was found between the ED section staffed by emergency medicine physicians and the section staffed by primary health care physicians (34.8% vs. 11.3%, p<0.001). Conclusions: The significant variation in haemolysis indices among the investigated units is likely to reflect varying preanalytical conditions. The HI is a valuable tool for estimation and follow-up of preanalytical quality in primary health care.

Place, publisher, year, edition, pages
2009. Vol. 47, no 8, p. 940-944
Keyword [en]
blood specimen collection, haemolysis, medical errors, phlebotomy, primary health care, Quslity indicators
Identifiers
URN: urn:nbn:se:umu:diva-21255OAI: oai:DiVA.org:umu-21255DiVA, id: diva2:211193
Available from: 2009-04-09 Created: 2009-04-09 Last updated: 2018-06-09Bibliographically approved
In thesis
1. Sources of preanalytical error in primary health care: implications for patient safety
Open this publication in new window or tab >>Sources of preanalytical error in primary health care: implications for patient safety
2009 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Background Venous blood tests constitute an important part in the diagnosis and treatment of patients. However, test results are often viewed as objective values rather than the end result of a complex process. This has clinical importance since most errors arise before the sample reaches the laboratory. Such preanalytical errors affect patient safety and are often due to human mistakes in the collection and handling of the sample. The preanalytical performance of venous blood testing in primary health care, where the majority of the patients contact with care occurs, has not previously been reported.

Aims To investigate venous blood sampling practices and the prevalence of haemolysed blood samples in primary health care.

Methods A questionnaire investigated the collection and handling of venous blood samples in primary health care centres in two county councils and in two hospital clinical laboratories. Haemolysis index was used to evaluate the prevalence of haemolysed blood samples sent from primary health care centres, nursing homes and a hospital emergency department.

Results and discussion The results indicate that recommended preanalytical procedures were not always followed in the surveyed primary health care centres. For example, only 54% reported to always use name and Swedish identification number, and 5% to use photo-ID, the two recommended means for patient identification. Only 12% reported to always label the test tubes prior to blood collection. This increases the possibility of sample mix-up. As few as 6% reported to always allow the patient to rest at least 15 minutes before blood collection, desirable for a correct test result. Only 31% reported to have filed an incident report regarding venous blood sampling, indicating underreporting of incidents in the preanalytical phase.

Major differences in the prevalence of haemolysed blood samples were found. For example, samples collected in the primary health care centre with the highest prevalence of haemolysed samples were six times (95% CI 4.0 to 9.2) more often haemolysed compared to the centre with the lowest prevalence. The significant variation in haemolysed samples is likely to reflect varying preanalytical conditions.

Conclusions This thesis indicates that the preanalytical procedure in primary health care is associated with an increased risk of errors with consequences for patient safety and care. Monitoring of haemolysis index could be a valuable tool for estimating preanalytical sample quality. Further studies and interventions aimed at the preanalytical phase in primary health care are clearly needed.

Place, publisher, year, edition, pages
Umeå: Institutionen för medicinsk biovetenskap, 2009. p. 72
Series
Umeå University medical dissertations, ISSN 0346-6612 ; 1250
Keyword
blood specimen collection, haemolysis, medical errors, phlebotomy, preanalytical, primary health care, quality indicators, quality of health care, questionnaires, specimen handling
National Category
Other Clinical Medicine
Research subject
Medicine
Identifiers
urn:nbn:se:umu:diva-21256 (URN)978-91-7264-741-1 (ISBN)
Public defence
2009-05-08, Sal 135, Byggnad 9A, Bv, Norrlands Universitetssjukhus, 901 85 Umeå, Umeå, 09:00 (Swedish)
Opponent
Supervisors
Available from: 2009-04-20 Created: 2009-04-09 Last updated: 2012-11-02Bibliographically approved

Open Access in DiVA

No full text in DiVA

Authority records BETA

Söderberg, JohanGrankvist, KjellHultdin, Johan

Search in DiVA

By author/editor
Söderberg, JohanGrankvist, KjellHultdin, Johan
By organisation
Clinical chemistry
In the same journal
Clinical Chemistry and Laboratory Medicine

Search outside of DiVA

GoogleGoogle Scholar

urn-nbn

Altmetric score

urn-nbn
Total: 200 hits
CiteExportLink to record
Permanent link

Direct link
Cite
Citation style
  • apa
  • ieee
  • modern-language-association-8th-edition
  • vancouver
  • Other style
More styles
Language
  • de-DE
  • en-GB
  • en-US
  • fi-FI
  • nn-NO
  • nn-NB
  • sv-SE
  • Other locale
More languages
Output format
  • html
  • text
  • asciidoc
  • rtf