The effect of the introduction of the phlebotomist on mislabelled blood specimens within the Emergency Department

Kelly Decker1, Sally Charlton1, Dr Joe D’Agostino1, Donna Williams1, A/Prof DeVilliers Smit1, Rebecca Atkins1

1The Alfred Emergency & Trauma Centre , Melbourne , Australia

BACKGROUND: Pathology collection is a frequent and common procedure performed within the Emergency Department (ED). Despite the frequency and clear process of pathology collection, mislabelled pathology specimens, particularly blood specimens,  were responsible for the highest number of reported clinical incidents in The Alfred Emergency & Trauma Centre in 2014. Delays incurred due to mislabelling ultimately result in delayed patient care, increase risk of harm, and requires further time investment to recollect the specimen.  Overall resulting in a poor patient experience and ineffective use of resources.  To address this issue, the introduction of a phlebotomist within the ED was trailed to study if this would have a positive effect on lowering the number of reported mislabelled blood pathology specimens.

METHODS: A project outline and timeline was developed in conjunction with key stakeholders. This included obtaining scope of practice approval, credentialing of phlebotomy staff in intravenous cannula insertion and development of an education and implementation packages. A single phlebotomist was rostered for one 6-hour shift per day in the peak patient presentation time. The total number of annual reported mislabelled pathology specimen incidents were collected pre, during and post the introduction of the ED phlebotomist.

RESULTS: The results post the introduction of the phlebotomist in the ED showed that the percentage of mislabelled blood specimens (as a proportion of the total number taken) had reduced compared to pre-implementation, however this number does remain high.

CONCLUSION: This study demonstrated a high number of mislabelled blood pathology specimen incidents in the ED. The introduction of the ED phlebotomist decreased the proportion of mislabelled pathology specimens in relation to the number of total pathology specimens collected in ED. Further strategies need to be implemented to continue to reduce the number of mislabelled blood pathology specimen incidents in the ED.


To come…