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Critical Care

Volume 18 Supplement 2

Sepsis 2014

Open Access

Biobanking in the emergency department: implementation of the Mayo Clinic Emergency Department Sepsis Biorepository

  • CM Clements1,
  • JR Anderson1,
  • J Uhl1,
  • MI Rudis1 and
  • FR Cockerill1
Critical Care201418(Suppl 2):P41

Published: 3 December 2014


Emergency DepartmentSevere SepsisBlood DrawEmergency Department PatientPatient Identification


Biomarker discovery research has not focused on the emergency department (ED) due to perceived lack of access to ED patients for study, difficult patient identification, and preemption by time-critical clinical needs. The aim of this study was to use an automated process to accrue, within the ED, a biobank of patients presenting at risk for severe sepsis.


Our group has previously derived an algorithm for identification of at-risk patients of which about 45% will be severely septic [1]. Here, we utilize that algorithm to identify a prospective cohort to be included in our ED sepsis biobank. Patients are excluded if they are pregnant, <18 years old, a vulnerable adult, or imprisoned. An electronic notification system identifies patients and automatically pages phlebotomy and laboratory processing personnel directly. Blood draws occur immediately after patient identification and at 6 and 24 hours into hospitalization. We use an IRB-approved delayed consent model that minimizes the time between identification and blood draw. Plasma extracts and cellular isolates are processed and stored immediately. Clinical data are extracted for relevant patient outcomes, severe sepsis, and indicators of critical illness.


In 1 year of accrual, the alert algorithm identified 1,773 eligible patients for screening. Blood was drawn from 873 patients based on phlebotomy availability and laboratory processing staffing. A total of 642 patients completed blood draws and consented for inclusion, with the balance of patients having been discharged, transferred, or deceased with no identifiable legally authorized representative for consent. The median time from alert to first blood draw was 25 minutes (range 5 to 60 minutes). In an observation period, during which 227 consecutive patients had blood drawn, only 12 patients or families (5.2%) declined consent after the initial blood draw.


We have successfully developed and implemented a biobank in the ED that functions within practice limitations and has high patient accrual. Automation is key for efficient implementation in the ED. Using automated design improvements, we obtain blood samples from sepsis patients presenting to the ED faster than previous studies. Prompt biobank collection within the ED allows research into mechanisms of sepsis earlier in a patient's hospital course than has heretofore been possible and enables biomarker discovery for testing development directly relevant to emergency providers.

Authors’ Affiliations

Department of Emergency Medicine, Mayo Clinic, Rochester, USA


  1. Attwood RJ, Smith VD, Russi CS, Hess EP, Escalante P, Baudoin MR, Frazee EN, Rudis MI: An automated electronic notification system as a screening tool for severe sepsis and septic shock. Ann Emerg Med 2010, 56: S64-S65.View ArticleGoogle Scholar


© Clements et al.; licensee BioMed Central Ltd. 2014

This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. The Creative Commons Public Domain Dedication waiver ( applies to the data made available in this article, unless otherwise stated.