Potential cost savings by minimisation of blood sample delays on care decision making in urgent care services

Conclusion
- Blood sample rejection rate in a single large NHS Foundation Trust is high.
- The highest rate of blood sample rejection is in the Accident and Emergency department.
- Blood sample rejection is associated with increased in-hospital stay.
- 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 cost.

BackgroundTimely 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 methodsRates 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.Results16,061 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%).ConclusionSample 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.