Real-world implementation of EUSEM/EuSEN/EFLM blood sampling recommendations in an adult emergency department: impact on hemolysis and potassium result availability

OBJECTIVES: In 2024, EUSEM, EuSEN and the EFLM WG-PRE jointly issued GRADE-based recommendations for blood sampling in emergency departments (EDs). Whether their implementation translates into measurable gains has not yet been reported. METHODS: Retrospective before-after study in the adult ED of a general hospital. Samples analyzed during two 3-month periods were compared: before (n=5,656 samples) and after (n=5,646) a bundled implementation, comprising a switch to lower-vacuum lithium-heparin tubes (from 3.5 mL to 2.5 mL draw volume, identical dimensions), use of discard tubes, and training of 23 of 35 nurses. The primary endpoint was the proportion of hemolyzed samples (HI≥20 AU). RESULTS: Hemolyzed samples fell from 52.1 % to 37.4 % (p<0.0001), the reduction being concentrated in the upper classes (HI≥40 AU: 28.7-14.5 %; HI≥100 AU: 10.5-2.9 %). Potassium results cancelled for hemolysis fell from 17.2 % to 5.5 % (p<0.0001), while 81.9 % and 85.3 % of cancelled results were not followed by recollection (p=0.20). The proportion of patients left without any usable potassium result fell from 13.1 % to 4.1 % (p<0.0001), i.e. 396 fewer patients over three months. Median time to usable potassium result was unchanged, but the proportion of patients with a result available within 2 h rose from 78.6 % to 91.3 % (p<0.0001). CONCLUSIONS: Implementing the hemolysis-related 2024 ED-specific recommendations reduced hemolyzed samples by 14.7 percentage points, halved moderate-to-severe hemolysis, and reduced threefold the proportion of patients left without a usable potassium result.