Education reduces unnecessary diagnostic blood sampling in the intensive care unit (ICU)

Introduction

Diagnostic blood sampling is an indispensable and effective tool for assessing critically ill patients. It has been demonstrated that a substantial blood volume is drawn daily from these patients [1]. A recent review of UK practice suggested a number of measures to reduce this [2]. Furthermore the recent introduction of an integrated electronic record-keeping system in our unit ensured that maximum information could be derived from each sample. In order to assess whether it is possible to optimise the amount of blood sampled, we performed a prospective cohort controlled study to compare blood volumes used for sampling before and after a 2 month education period.

Method

Sample frequency for both laboratory investigations and near-patient testing (NPT) was derived from the electronic record for all patients treated in our ICU during two periods of 2 months. Education included information on unit guidelines on sample requirements, demonstration of the benefit of end-tidal measurements and oximetry, the accuracy of near-patient equipment, as well as education of a new technique designed to minimise blood wastage. Cost per sample was provided by the laboratory management. All sample data were evaluated on a per patient-day basis.

Results

There was a significant reduction in total volume, blood wastage, the frequency of laboratory and near-patient tests performed and overall cost following education (Table 1). Demographics were not significantly different in the two groups.

Table 1

Conclusions

Education can significantly reduce the volume of blood used for sampling by ensuring that full use is made of all information. Our data suggest that this volume is clinically important and, furthermore, that this approach can also produce substantial cost saving.