Phlebotomists in Emergency Department Triage. Mixed method studies.

Abstract

Background: The demand for Emergency Department (ED) services, both in terms of patient numbers and complexity has risen over the past decades with reports of increased ED patient presentation rate from 321 per 1000 to 339 per 1000 between 2017-18 and 2021-22. Consequently, new care models to address this surge in demand, mitigate associated risks, and improve overall safety have been introduced. Among these models is the concept of "front loading" clinical care, involving the initiation of interventions at the point of arrival. This study evaluates the impact of introducing phlebotomists at triage. Methods: Mixed methods of cross-sectional design incorporating reflexive thematic analysis and observational propensity scores matched design for the year 2021 and 2023 were utilised. Results: Cross-sectional survey response rate was 61% (n=207). All staff awareness of phlebotomy service at triage was 99.5% even though, only 57% of the staff reported working in triage (p=0.048, CI-0.0001599 to 0.043073). Valuable/vital resource’ featured as a common response. Early decision making, patient safety, staff and patient satisfaction emerged as consistent themes. Propensity score matching involved 91,283 patients. We observed a higher frequency of blood tests (60.4% vs. 52%, p< 0.001) and electrocardiograms (ECGs) (16.5% vs. 19.1%, p< 0.001), a decrease in patients transferred from triage to ED cubicles (75.9% vs. 78%, p< 0.001), and an increase in admissions to short-stay unit (5.8% vs. 3.2%, p< 0.001). While the overall ED length of stay increased (mean 310 to 318 minutes) there was a reduction in mean ED time for admitted patients which was statically significant. Conclusion: Staff have identified the tasks, and the concierge role provided by the phlebotomists as contributions to enhanced patient care and safety. Improvement in timely patient blood gas results and ECG interpretation, leading to prompt care and triage re-evaluation where necessary were observed. Increased staff satisfaction has been reported.