降低急診血液檢體退件率

Reducing the Rejection Rate of Blood Specimen Collection in Emergency Room

本單位2017年1至4月血液檢體異常退件率1.16％，超過本院目標值0.95％。在急診，血液檢體退件率的增加，可能會延誤治療並危及病人安全，進而造成急診醫療品質下降。專案小組經現況分析後發現單位採集檢體被退件的原因和護理師的認知不足以及採集的檢體發生溶血、凝固、檢體量不足等異常狀況有關。藉由修訂急診採集檢體標準流程及檢體採集輔助工具如：設置提醒計時器、注血試管順序提示卡、創新不倒翁檢體搖擺機及檢體量比對彩虹架等改善措施介入後，本單位急診檢體退件率由1.16％降低為0.7％；同時，單位護理師採集檢體認知正確率由76.3％提升為96.2％，採集檢體行為正確率由70.9％提升到96.7％，專案改善效果顯著。本專案藉由跨團隊合作，改善採集檢體品質，進而提升醫療判斷正確性，可做為相關單位之參考。

About 1.16% of blood specimens taken at the emergency ward from January to April 2017 were rejected, which exceeded the target value of 0.95%. Rejection of blood specimen can lead to delayed treatment and declined quality of emergency care. After analyzing, we found several causes of incorrect blood sampling, including hemolysis, coagulation, and insufficient sample volume. The task force of the improving project revised the standard procedure for blood sample collection at emergency department and designed sample collection aids, such as the timer reminder, the reminder card for injecting blood into test tubes, innovative tumbler body sample shaking machine, and rainbow volume indicative comparator, among others, to reduce the abnormal rejection rate. After implementation, the rejection rate decreased from 1.16% to 0.7%; meanwhile, the recognition increased from 76.3% to 96.2%, and the accuracy of sample collecting increased from 70.9% to 96.7%, reaching the goal of the improving project. This cross-functional team project successfully improved the quality of blood sample collection and emergency care.