通过尽量减少紧急护理服务中血样采集延迟对护理决策的影响来实现潜在的成本节约。
Potential cost savings by minimisation of blood sample delays on care decision making in urgent care services.
作者信息
Bodansky David M S, Lumley Sophie E, Chakraborty Rudrajoy, Mani Dhanasekaran, Hodson James, Hallissey Mike T, Tucker Olga N
机构信息
Department of Surgery, University Hospitals Birmingham, Birmingham, UK.
Health Informatics Unit, University Hospitals Birmingham, Birmingham, UK.
出版信息
Ann Med Surg (Lond). 2017 Jun 16;20:37-40. doi: 10.1016/j.amsu.2017.06.016. eCollection 2017 Aug.
BACKGROUND
Timely availability of blood sample results for interpretation affects planning and delivery of patient care from initial assessment in Accident and Emergency (A&E) departments.
MATERIALS AND METHODS
Rates of, and reasons for, rejected blood samples submitted from all clinical areas over one month were evaluated. Haemoglobin (Hb) represented haematology and potassium (K), biochemistry. A prospective observational study evaluated the methodology of sample collection and impact on utility.
RESULTS
16,061 haematology and 16,209 biochemistry samples were evaluated; 1.4% (n = 229, range 0.5-7.3%) and 4.7% (n = 762, range 0.9-14%) respectively were rejected, with 14% (n = 248/1808) K rejection rate in A&E. Patients with rejected K and Hb had a longer median in-hospital stay of 9 and 76 h respectively and additional stay fixed costs of £26,824.74 excluding treatment. The rejection rate with Vacutainer and butterfly (4.0%) was lower than Vacutainer and cannula (28%).
CONCLUSION
Sample rejection rate is high and is associated with increased in-hospital stay and cost. Blood sampling technique impacts on rejection rates. Reduction in sample rejection rates in emergency care areas in acute hospitals has the potential to impact on patient flow and reduce cost.
背景
及时获取血液样本检测结果以进行解读，会影响到急诊部门从初始评估开始的患者护理规划与实施。
材料与方法
对一个月内所有临床区域提交的被拒收血液样本的比例及原因进行评估。血红蛋白（Hb）代表血液学指标，钾（K）代表生化指标。一项前瞻性观察性研究评估了样本采集方法及其对实用性的影响。
结果
共评估了16,061份血液学样本和16,209份生化样本；分别有1.4%（n = 229，范围0.5 - 7.3%）和4.7%（n = 762，范围0.9 - 14%）的样本被拒收，急诊部门钾样本的拒收率为14%（n = 248/1808）。钾和血红蛋白样本被拒收的患者中位住院时间分别延长了9小时和76小时，且不包括治疗费用的额外住院固定成本为26,824.74英镑。使用真空采血管和蝶形针采血的拒收率（4.0%）低于使用真空采血管和套管针采血的拒收率（28%）。
结论
样本拒收率较高，且与住院时间延长和成本增加相关。采血技术会影响拒收率。降低急性医院急诊护理区域的样本拒收率有可能影响患者流程并降低成本。
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