Emergency Services Institute, Cleveland Clinic Health System, Cleveland, OH, USA.
Medical Economics, Cleveland Clinic Health System, Cleveland, OH, USA.
J Appl Lab Med. 2021 Nov 1;6(6):1607-1610. doi: 10.1093/jalm/jfab035.
On average, patients with hemolyzed potassium samples spend about 1 h longer in the emergency department (ED), regardless of acuity level or disposition. We aimed to quantify the direct expenses associated with poor-quality preanalytic blood samples collected in the ED.
We created a simple table with a range of direct expenses (i.e., costs) and rates of hemolyzed sample draws, allowing for identification of potential high-level cost-of-care impact analysis. We included a range of costs informed by review of literature on the topic. Those costs range from $600 to $3000 per bed-hour. This amount was inflation adjusted from 1996 to 2020 (1.68 × [direct cost per visit] × [100 000 visits per year/365 days/24 h]). We provided a range of hemolysis incidence based on previously reported data.
We showed that for an ED with 100 000 annual visits, a 40% draw rate for routine chemistries (including potassium), and a 10% hemolysis incidence, the direct cost impact of hemolysis waste is approximately $4 million/year as a result of the 1 h of added length of stay on average for a patient with a hemolyzed blood sample. This amount represents an annualized estimated cost of caring for a patient in the ED with an avoidable extended length of stay.
The financial burden of poor-quality blood samples can be estimated using cost per bed-hour and rate of sample failure. Similar methodology may identify additional QC issues with previously invisible financial implications.
无论患者的 acuity 水平或处置方式如何，平均而言，溶血的钾样本患者在急诊科（ED）停留的时间约延长 1 小时。我们旨在量化与 ED 采集的质量差的分析前血液样本相关的直接费用。
我们创建了一个简单的表格，其中包含一系列直接费用（即成本）和溶血样本采集率，可用于确定潜在的高成本护理影响分析。我们根据该主题的文献回顾确定了一系列费用。这些费用范围为每床每小时 600 美元至 3000 美元。该金额根据 1996 年至 2020 年的通货膨胀进行了调整（[每次就诊的直接费用]×[每年 100000 次就诊/365 天/24 小时]×1.68）。我们根据之前报告的数据提供了溶血发生率的范围。
我们表明，对于每年有 100000 次就诊的 ED，如果常规化学检查（包括钾）的采集率为 40%，溶血发生率为 10%，则由于溶血导致的平均每位患者停留时间延长 1 小时，溶血浪费的直接成本影响约为每年 400 万美元。这一数额代表了因可避免的延长住院时间而在 ED 中照顾患者的年化估计成本。
可以使用每床每小时的成本和样本失败率来估计劣质血液样本的财务负担。类似的方法可能会发现以前看不见的财务影响的其他 QC 问题。
