Seeing red: Blood sample hemolysis is associated with prolonged emergency department throughput
Creator
Phelan MP; Hustey FM; Good DM; Reineks EZ
Publisher
Journal of Applied Laboratory Medicine
Date
2020
2020-07
Description
Introduction: Hemolyzed emergency department (ED) blood specimens impose substantial burdens on various aspects of delivering care. The ED has the highest incidence of hemolysis among hospital departments. This study assessed the association and potential impact of hemolyzed blood samples on patient throughput time using ED length of stay (LOS) as the primary outcome measure. Methods: This study was a secondary analysis of data collected during a performance improvement project aimed at reducing the incidence of hemolysis in ED blood specimens. The electronic medical record was queried for potassium orders and results and for key patient throughput time points. Throughput times were stratified according to hemolysis, ED disposition (admitted vs discharged), and Emergency Services Index (ESI) triage categorization. Two-tailed t tests were used to compare throughput times for patients with and without hemolysis. Results: Potassium values were reported for 11 228 patient visits. The mean ED LOS was 287 minutes for patients with nonhemolyzed samples and 349 minutes for patients who had hemolyzed samples, a mean delay of 62 minutes. The mean throughput time for discharged patients was 92 minutes shorter in the group without hemolysis (337 vs 429 minutes). The mean throughput time for admitted patients was 28 minutes shorter in the group without hemolysis (264 vs 292 minutes). The increased LOS for patients with a hemolyzed blood sample was independent of the most commonly encountered ESI levels. Conclusion: Hemolysis of blood samples obtained in the ED is associated with patient throughput via delays in patient disposition, independent of various markers of acuity, such as the patients' ultimate disposition or triage categorization.
The Six-item Screener to Detect Cognitive Impairment in Older Emergency Department Patients.
Creator
Wilber S T; Carpenter CR; Hustey FM
Publisher
Academic Emergency Medicine
Date
2008
2008-07
Description
BACKGROUND: Cognitive impairment due to delirium or dementia is common in older emergency department (ED) patients. To prevent errors, emergency physicians (EPs) should use brief, sensitive tests to evaluate older patient's mental status. Prior studies have shown that the Six-Item Screener (SIS) meets these criteria. OBJECTIVES: The goal was to verify the performance of the SIS in a large, multicenter sample of older ED patients. METHODS: A prospective, cross-sectional study was conducted in three urban academic medical center EDs. English-speaking ED patients \textgreater or = 65 years old were enrolled. Patients who received medications that could affect cognition, were too ill, were unable to cooperate, were previously enrolled, or refused to participate were excluded. Patients were administered either the SIS or the Mini-Mental State Examination (MMSE), followed by the other test 30 minutes later. An MMSE of 23 or less was the criterion standard for cognitive impairment; the SIS cutoff was 4 or less for cognitive impairment. Standard operator characteristics of diagnostic tests were calculated with 95% confidence intervals (CIs), and a receiver operating characteristic curve was plotted. RESULTS: The authors enrolled 352 subjects; 111 were cognitively impaired by MMSE (32%, 95% CI = 27% to 37%). The SIS was 63% sensitive (95% CI = 53% to 72%) and 81% specific (95% CI = 75% to 85%). The area under the receiver operating characteristic curve was 0.77 (95% CI = 0.72 to 0.83). CONCLUSIONS: The sensitivity of the SIS was lower than in prior studies. The reasons for this lower sensitivity are unclear. Further study is needed to clarify the ideal brief mental status test for ED use.
Subject
Female; Male; Aged; Sensitivity and Specificity; Prospective Studies; ROC Curve; Geriatric Assessment; Academic Medical Centers; Confidence Intervals; Psychological Tests; Human; Cross Sectional Studies; Emergency Service; Cognition Disorders – Diagnosis; Emergency Medicine – Equipment and Supplies