Spencer Seballos, BA

Cleveland Clinic Foundation

“Lab Sample Hemolysis: Emergency Nurses’ Knowledge, Attitudes and Practice”
SAEMF/RAMS Medical Student Research Grant




Hemolysis of blood samples impairs laboratory analysis and necessitates redraws from patients, causing increased costs, patient discomfort, longer wait times, and delayed clinical decision making. These issues are of particular importance to Emergency Departments (EDs), in which efficient workflow is of the utmost importance. Although several factors during the blood draw process have been identified to reduce in vitro blood sample hemolysis rates, the hemolysis rates of EDs are have repeatedly been found above nationally identified benchmarks. Because nurses are frequently involved with blood draws in the ED, this project seeks to identify the knowledge, attitudes and practices of emergency nurses with respect to sample hemolysis. We hypothesize that there is a low prevalence of ED nurses’ knowledge or implementation of specific strategies that alter sample hemolysis rates, even though they are aware of how problems with blood sample hemolysis can impact patient care in EDs, to be explored with the following specific aims: first, we aim to study to what extent ED nurses are aware of pre-analytic variables associated with decreased rates of blood sample hemolysis, and whether they report implementation strategies to reduce hemolysis rates in their respective EDs. Second, we aim to assess demographic and institutional process variables that are associated with decreased knowledge about lab sample hemolysis. This quantitative, cross-sectional study will use a computer-based survey of a random sample of emergency department nurses from the Emergency Nurse’s Association (ENA), the national organization representing emergency department nurses from across the US. Survey questions will ask respondents about current role, demographic information, as well as knowledge, attitudes, and practices related to handling of blood specimens. Questionnaire items were developed via an expert consensus process in conjunction with the Office of Nursing Research and Innovation at the Cleveland Clinic.

As government-implemented quality metrics become more important in assessing patient care and determining hospital reimbursement, it is essential that emergency medicine physicians and front-line staff understand areas of inefficiencies – such as blood sample hemolysis – and how these can be corrected in an interdisciplinary manner.

Research Results

Dr. Seballos is still completing the project.