Blood Sample Rejection Rates in the Emergency Department

Background: The national average for laboratory rejection of blood samples ranges from 0.3% to 0.8%. The rate of rejection at a local emergency department averaged 2.8% in 2014. Purpose: Discover prevalent causes of laboratory blood sample rejection in the emergency department and determine best practice for maintaining acceptable rejection rates. Methods: Analyze data from the hospital laboratory to identify reasons for blood sample rejection and which personnel procured the rejected samples. Review literature to find common sources of error and explore evidence based practices in drawing blood for laboratory testing. Results: Data showed that hemolysis and clotting were the main reasons for blood sample rejection. Registered nurses were responsible for the largest number of rejections. Literature states best practice is to avoid using intravenous catheter starts for drawing blood samples and to use phlebotomists for lab draws rather than registered nurses. Discussion/Recommendations: Registered nurses may have higher rejection rates because of their tendency to draw blood from intravenous catheter starts. Therefore, the first recommendation is to revise policy and educate personnel to avoid this method of obtaining blood samples. The second recommendation is to use a dedicated phlebotomist or technician for blood draws instead of registered nurses. Considering the effect of laboratory rejections on efficient care delivery, healthcare costs, and patient satisfaction, reducing the blood sample rejection rate in the emergency department should be prioritized